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  1. #1
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    Default New article on sudden death in competing horses.

    http://www.thehorse.com/ViewArticle.aspx?ID=16725

    Takes a different path than the aortic rupture/EIPH theories that have been talked about so much, but no less interesting and more information and new angles of research are NEVER bad.
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  2. #2
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    Quote Originally Posted by deltawave View Post
    http://www.thehorse.com/ViewArticle.aspx?ID=16725

    Takes a different path than the aortic rupture/EIPH theories that have been talked about so much, but no less interesting and more information and new angles of research are NEVER bad.
    I saw this today, and was wondering if the various researchers from different disciplines would be comparing notes. Let's hope so.
    "Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it." ~ Mark Twain



  3. #3
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    Exclamation Interesting, hmmm?

    Interesting article! could this be what happened to lucindas' horse, who, , after jumping clean sj at badminton; accepting the trophy, died suddenly after the victory gallop? I have a question for you about stress tests for humans, which, I will send you privately; for referring us to this article!
    breeder of Mercury!

    remember to enjoy the moment, and take a moment to enjoy and give God the glory for these wonderful horses in our lives.BECAUSE: LIFE is What Happens While Making Other Plans



  4. #4
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    raises a lot of questions, doesn't it?
    breeder of Mercury!

    remember to enjoy the moment, and take a moment to enjoy and give God the glory for these wonderful horses in our lives.BECAUSE: LIFE is What Happens While Making Other Plans



  5. #5
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    Interesting article... Though Im sure they are a long way from it, hopefully looking into finding the cause and signs of this could save some horses. Im sure a collaboration between racing, eventing and other affected sports would be useful. My friend at vet school was talking awhile back on how she would love to be able to research this as its one of the major things that her classes and professors couldnt fully explain.
    RIP Charlie and Toby

    Adventures



  6. #6
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    Number one, please note these are Standardbred race horses. We are WAY talking about apples and oranges between Standardbred race horses and even Thoroughbred racehorses here, JMHO. I have my trainer's license, and I've trained both breeds in racing stables. The Standardbred training system is WAY more conditioning and far more tuned to warmup and cool down than Thoroughbred. They're also slower at racing speeds than a T-bred.

    Since most event horses are Thoroughbred, this data while nice, is pretty far from the conditions under which we event our upper level event horses. And it's not very close to what we do with the lower level horses either. We are so much slower -- we don't use that speed. The intensity of the exercise we do is more oriented to power, such as jumping. I mean, it's still a horse, yes, and they are being exercised. But Delta, unless you used a standard stress test for every horse doing every sort of competition, (think big fat halter horses vs. Rolex contenders) wouldn't the numbers vary widely? Or is the heart the same organ over and over again regardless of fitness level, stress, weight, condition? Is this study saying that or is it just saying among SOME racing Standardbreds, we have found a distinct pattern on cool down?

    I would equate a racing Standardbred fitness level to about Training, perhaps Prelim level eventing (VERY loosely as there is just very little comparison as to stress, speed, acceleration levels, etc.) It's very VERY hard to extrapolate any of this to eventing, in my opinion. It's interesting -- but relevant -- hmmm. Delta, can you explain the relevancy?
    "Passion, though a bad regulator, is a powerful spring." -- Emerson
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  7. #7
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    To Carol, whose Private Message inbox is full, here is my reply--no reason (I don't think) it couldn't be shared. Hope that is OK?

    The incidence of people dying after (and even during) a stress test is actually very low, but it does happen. The perceived incidence among the loved ones, acquaintances and friends of the person it actually happens to is high, and it tends to get blown out of proportion. But the actual incidence is very small.

    The reason this happens even occasionally in humans may be that every now and then we put someone on a treadmill who is not at all fit, and the effort "provokes" something that maybe might never have happened if they had just kept sitting on the couch doing nothing.

    Another reason might be that that person was headed for an MI anyhow, and we just happened to have terrible timing. Coincidence. It happens.

    Since horses do not have the type of heart disease that causes 95% of "sudden death" in humans, it's probably not relevant to compare the two species in this regard.

    Presumably, event horses are FIT, and the act of stressing them is not unique or unusual, which would not necessarily be the case in a human having a stress test who might be very UNFIT (as in the first scenario I mentioned). So again, apples to oranges a little bit.
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  8. #8
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    I would equate a racing Standardbred fitness level to about Training, perhaps Prelim level eventing (VERY loosely as there is just very little comparison as to stress, speed, acceleration levels, etc.) It's very VERY hard to extrapolate any of this to eventing, in my opinion. It's interesting -- but relevant -- hmmm. Delta, can you explain the relevancy?
    I'm not sure at this stage that there is ANY way to draw parallels. Yes, these were Standardbreds, but the point is not (at this stage) to make conclusions. They are merely making observations and collecting data, in the hopes that the NEXT STEP would be to focus down and learn more in the real world. This type of preliminary study isn't meant to ANSWER questions, merely to find BETTER ONES TO ASK.

    I personally think it opens up a lot of new avenues--we have focused a lot on mechanical/vascular problems, not so much on arrhythmia problems. HUGE difference, potentially same outcome--a dead athlete. NO piece of understanding is irrelevant or unnecessary, IMO.
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  9. #9
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    I wonder if this is some of the issue my advanced eventer had. He was Irish Draught, but always the fit anxious type. We had 0 problems with him until after Rolex in 2003 when we started having little health issues here and there. Fast forward a year and he is diagnosed EIPH with a whoppin heart arrhythmia. We had to retire him at that point and over the next 2 years he had 2 rather dramatic episodes of an a-fib attack. Went from being fine, to barely being able to walk, depressed looking. This was confirmed at the vet hospital as they were already on speed dial for him and actually saw him only 2 hours after the second a-fib. I wonder if he had the same heart irregularity that they saw in these standardbreds, but you would think it would have been caught in one of the D box's he had to go thru.



  10. #10
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    Does this suggest anything to do with calcium?
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  11. #11
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    To mjrtango, I have not pulled the full citation (yet!) to see if they commented on atrial fib, but my educated guess is that they would consider that a separate entity. (still an arrhythmia, but different than what I believe they were seeing here)

    Viney, again I have to see the full citation but certainly there is much in the electrical system of the heart, particularly repolarization (when bad electrical things happen) that is mediated--at least in part--by calcium, on a subcellular level.

    MANY more questions than answers, but even a single step forward is a good thing.
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  12. #12
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    Swale was the first thing that came to mind when I read "The Horse" piece.
    "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

    ...just settin' on the Group W bench.



  13. #13
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    Quote Originally Posted by deltawave View Post
    To mjrtango, I have not pulled the full citation (yet!) to see if they commented on atrial fib, but my educated guess is that they would consider that a separate entity. (still an arrhythmia, but different than what I believe they were seeing here)
    I wonder if what they were seeing though could have been a pre-curser to the full a-fib attacks he had while in pasture. I don't know much about horses and how their hearts work, so not even sure it would be possible to start with the arrhythmia they discuss in the article and perhaps cause enough damage to cause a-fib attacks later on. All I know is if I was going thru all this with Tango now I have a feeling we would have had a better shot at figuring out what was wrong with him then 7 years ago when all this was fairly new and just starting to be looked at in the performance horses. Tango in both the 10 minute box and D box always ran hot (typical irish horse) but cooled and had heart rate dropped really quickly. Oh well he is retired to Hawaii with some friends now anyway and living the life!

    Tango actually could have used an equine cardiologist. He had an interesting drop beat, and his heart could slow to the speed that you could hear all 4 chambers beat seperately. Whenever we were at the vet hospital he was swarmed with everybody from the teaching vets, to the vet students and everybody in between. They wanted to put a halter moniter on him, but he would have had to stay overnight and he was such a stress cadet they were afraid he'd colic on them. It's really not a good thing to own the celebrity of the hospital!



  14. #14
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    Quote Originally Posted by mjrtango93 View Post
    ... I wonder if he had the same heart irregularity that they saw in these standardbreds, but you would think it would have been caught in one of the D box's he had to go thru.
    A quick comment here, sadly, it is highly doubtful that any vet will ever be able to detect irregularities in a heart in this environment. It is too uncontrolled and too rushed. I have worked a few D boxes and know many vets who have. You hear too many differential hearts to know what and or if something is not normal.

    Unless there is fully instrumented cardiac set-ups on horses from warm-up through cool down, it will be very hard to know due to the uncontrolled competition environment.

    Reed



  15. #15
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    Quote Originally Posted by RAyers View Post
    A quick comment here, sadly, it is highly doubtful that any vet will ever be able to detect irregularities in a heart in this environment. It is too uncontrolled and too rushed. I have worked a few D boxes and know many vets who have. You hear too many differential hearts to know what and or if something is not normal.

    Unless there is fully instrumented cardiac set-ups on horses from warm-up through cool down, it will be very hard to know due to the uncontrolled competition environment.

    Reed
    That makes sense, and they don't listen to them for more then a couple seconds so you wouldn't catch the changes.



  16. #16
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    not even sure it would be possible to start with the arrhythmia they discuss in the article and perhaps cause enough damage to cause a-fib attacks later on
    One can never say never in medicine, but I doubt it. No "damage" is required to cause atrial fibrillation. Sometimes it just happens in perfectly normal, healthy hearts. And from what I can glean from the short bit presented in The Horse, it sounds like they're talking about ventricular arrhythmias, not atrial ones. Very, very different kettle of fish.
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  17. #17
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    Quote Originally Posted by deltawave View Post
    One can never say never in medicine, but I doubt it. No "damage" is required to cause atrial fibrillation. Sometimes it just happens in perfectly normal, healthy hearts. And from what I can glean from the short bit presented in The Horse, it sounds like they're talking about ventricular arrhythmias, not atrial ones. Very, very different kettle of fish.
    Uh oh.
    Better give us the .25 explanation, Delta.

    By the way....this might be a fairly common Standardbred phenomenon. I have helped hold up several in the race paddock, over the years, that were in what the vets called atrial fibrillation when they were passing out and we were trying to keep their heads and necks up so the IV could run into the vein fast enough. It takes 10 people to hold up a horse that is passing out, at least, so it was always an "all available folks in the paddock please go to Stall No. whatever", all-hands-on-deck, everybody-help sort of thing, so that's how I know about it. They get really woozy. They never wanted to let them go down. The trainers call this "a heart flip" in their venacular.
    A very big racehorse right near me actually had this happen at the Meadowlands a couple of weeks ago; he qualified back last week and is in to go in the Governors Cup race at the Delaware State Fair on Thursday. Yep, it's a tough breed.
    "Passion, though a bad regulator, is a powerful spring." -- Emerson
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  18. #18
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    What is this, an HMO? I didn't go to school and train for fourteen years to give $0.25 explanations! It's going to cost you more than that! But all kidding aside, although I pride myself on being able to translate doctor-talk into English, getting this into digestible form is pretty challenging.

    This is the really relevant passage from the "The Horse" article.

    They found that in 16% of horses, heart rate slowing after the race was associated with complex and potentially serious ventricular rhythm disturbances. In one-third of horses with these rhythm disturbances, heart rate slowing after the race was initially gradual, then rate slowed suddenly, then sped up, and then slowed down gradually again. Arrhythmias occurred during these rapid slowing events in these horses.
    They specifically denote "ventricular" arrhythmias, meaning the bad rhythm originates from the ventricles, NOT the atria. This would pretty much exonerate atrial fibrillation, I think. Take it off the list, at least in terms of THIS entity in THIS study.

    What they seem to be talking about here are potentially nasty, nasty rhythms, sometimes fatal, because (as in the case of a-fib, for example) if the atria are off doing their own thing that still leaves the ventricles to work, even at less than optimum efficiency. But if the VENTRICLES start doing their own thing, well, they ain't pumping any more. Worst case scenario here is degeneration into ventricular fibrillation, as in "get the paddles".

    The fact that these rhythms start happening during periods of rapid slowing/speeding up suggests to me (and I'm NOT an electrophysiologist or rhythm specialist but I sure will be showing my colleagues who ARE the full article when I get it) the kind of rhythm problem that could be genetic, and is dependent on the complicated flux of potassium, sodium, and calcium in and out of the heart's electrical and muscle cells. These things are very sensitive to changes in the rate and it sort of takes a "perfect storm" to set off a chain of events that leads to VF, but seeing the precursors on monitoring is very alarming, even if the animal seems fine.

    Again, this is PRELIMINARY research and I'm doing a LOT of speculating here.
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  19. #19
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    Not all of it is relevant (probably) but if you do an emedicine or WebMD search on the term "torsade des pointes" you can find more information on the biology/physiology in question.
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  20. #20
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    I have no idea about the biochemistry, so ignore this. But I'm wondering if intense exercise might somehow alter the proportions of the necessary metals (?) in the blood, which could lead to the finely balanced system malfunctioning.

    One thing that is sort of interesting is that some race trainers have been known to illegally milkshake their runners. What that means is that a concoction of bicarbonate of soda, water, sugar, and some other minerals are flushed into the stomach through a tube pre-race. I'm not sure how far pre-race, but one would think it had to be done at least a few hours before. Milkshaking is prohibited everywhere, but well known trainers have been caught doing it fairly recently. It's considered definitely performance enhancing, and the trainer's win records have suffered after they were caught. Perfect example is the trainer Jeff Mullins in California.

    The benefit is supposedly that this mixture delays the creation of lactic acid, but somehow that seems sort of like voodoo science. But might not altering the amount of calcium, sodium and potassium in the system right before intense exercise have other effects also?
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