So as some of you may know, I have an older TB gelding with a heart murmur. The heart murmur was first found out about when my vet was treating his lymphangitis...which was about a year ago. It was the loudest she had ever heard and was very concerned he could "drop dead any time now" . The vet had me freaked out and a mess, but I came to COTH, asked questions, and managed to calm myself down (thanks guys!). At that point his heart rate was "normal", I believe the vet was getting it at about 35 bpm. She gave me signs to watch out for, fluid in his chest, legs swelling, exercise intolerance, and difficulty breathing. But through the rest of the summer, fall, winter, he seemed completely normal. Up until about a month ago the horse was bouncing off walls.
The vet was out in early April and noted that his HR was up a bit. But vet and I didn't really think much of it because this is a horse that gets nervous easily and doesn't particularly like vets. Then horse went off his feed about a week ago, the same day the vet was coming to finish up with spring shots. She did a once over, noted that his HR was definitely high, she said she caught it as high as 62 bpm, but was mostly in the mid 50's. Didn't necessarily say that going off his feed had anything to do with the HR increase, but since he wasn't acting colicky and is on a free choice forage diet (so IMO pretty much ruling out ulcers) I started to panic again, and realized that over the past few weeks he had been *calmer*. I couldn't remember the last time he had really run just to run, he was much better ground tying (can't straight tie or x-tie as he pulls back), and overall a little less up. I attributed it to the heat and possibly just some old age, creaky arthritis issues (he's OT and retired at age 13!), but with the elevated HR I panicked again. So the next day, when he started acting colicky again, (after he ate his morning grain) I didn't know what to think. I had a vet out who tubed him with oil and a water electrolyte mix, and said to withhold food for 24 hours. Did that, brought him back onto food slowly (he is just back to a normal diet a week later), and now he seems fine, eating normally, etc.
However his heart rate is still high, as in high 40's-low 50's high. I've been watching him closely, and while I wouldn't say he is exercise intolerant, he would much rather just hang out, graze, etc, than run around with his pasture buddy. I've been taking him on some trail walks (in hand) just to see if he would get tired, and he doesn't seem to be, the only time he seemed to be breathing heavy is after walking up and down a pretty steep hill, and even then he was still ready to *go* just breathing harder. He will still follow me around the ring and over jumps without fuss. He doesn't seem to have any fluid build up in his chest or legs, his respiration seems normal as well.
He has lost a bit of weight, but I think that is from half starving him for almost a week due to the colic. It isn't weight loss anyone else has noticed, just me. His coat is shiny, he's bright eyed, and doesn't seem in any distress. I don't know what to think at this point.
The vet will be coming back out in the next week or so to re-check his heart rate and give him a once over (along with the rest of his spring shots) so I plan to mention what I've said on here to her, but she isn't very knowledgeable about heart murmurs so I tend to take whatever she says with a grain of salt.
I just don't know what to think here. Part of me says I should be mentally preparing for when it's "time", and the other part wants me to blow it off as nothing.
So what are my options at this point? Wait and see? Any drugs? I love this horse dearly but I can't spend a ton of money on him. He's 20, retired, has behavioral issues, and lymphangitis flare ups that have happened every year at the same time since I've had him. He lives the good life, I want to keep it that way. I won't trailer him to any big vet clinics because of his overall mental issues, he gets stressed by new situations and doesn't trailer well.
Sorry for the novel btw, just wondering what everyone's opinions are and if anyone has ever gone through something similar.
I just have a gut feeling that he's getting closer to the "time".
Yes, I did have something similar happen with my beloved TB Cupola. He was doing great into his early 20s, I was riding him about 3-4 times per week, and everything was fine. He did present with more 'calmness' or lethargy, but this was only noticeable really in retrospect, and it came on slowly. One day he had a sinus infection...a new vet in the practice came out and mentioned he had a heart murmur that no one had heard before. We tentatively thought bacteria might have migrated to the mitral valve, and in treating the sinus infection, it might resolve. We tried multiple rounds of antibiotics, all of which unfortunately caused extreme reaction requiring nearly daily emergency visits, giving fluids, banamine, etc. to manage colic responses to drugs.
After three weeks, the heart murmur was much worse. I had a cardiac expert come to the barn to do an EKG and we learned that what we thought was the sound related to a heart murmur was not that at all.
With a continued elevated heart rate, I'd get someone out who knows more than just a little about heart murmurs to determine whether that's what it is or if there is something else going on.
I'll be watching this post intently as my 4 year old just got diagnosed with a Grade 3 murmur today. Regular DVM says most likely retire her but I'm waiting to get her down for an ultrasound with a specialist to confirm. She was tiring and getting winded more easily then I thought normal for her age so I had her checked. I'm so devastated and pouring through the brilliant minds of COTH trying to calm down. I can't believe this is happening:-(
"We don't stop playing because we grow old; we grow old because we stop playing."
You cannot say what is wrong with the heart without an ultrasound. The grade/loudness of a murmur correlates VERY VERY poorly with the severity of whatever the specific lesion is.
Without an echocardiogram, it is IMPOSSIBLE to say for sure what might be the treatment options or the prognosis.
To make prognostic or treatment declarations based upon listening to a murmur is like listening to a car's engine running and saying how many miles are on it or what might (or might not) be wrong with the radiator. Does not compute.
SAcres- I fully appreciate not wanting to trailer a nervous horse. I'd be looking for someone to come out to the barn to do an ultrasound so you have some real information about what his problem is and if there are treatment options available.
Does anyone know of someone in SE PA that might be willing to come out? I don't want to spend a ton of money but it might be worth the peace of mind just to know what is going on, how fast the progression might be, etc, etc.
Deltawave, I do realize it is impossible to diagnose exactly what is going on with the heart but my options are limited due to this horse's er...mental state. I refuse to trailer him somewhere unless he is sedated. But I do think someone is worsening with his heart because he didn't use to have such a high heart rate.
So sorry that is happening to you Keg, I can't imagine how devastating it must be. I was so broken up finding out my completely retired horse (who I got as a companion and never really rode) had a heart murmur. It's a terrible situation to be in. From what I've read though, a lot of horses live good lives even with murmurs, so there is hope for your horse!
Ric Birk or Mary Durando, both vets with excellent "chops" in equine cardiology. Cohorts (along with me, although my role is small) on the Cardiovascular Research Initiative that the USEA is doing and very well-versed in equine echocardiography.