Diagnostic approach to exercise intolerance in racehorses

Abstract

The diagnostic approach to the exercise intolerant racehorse depends on sound, fundamental steps to allow complete examination of the entire horse in a logical, time-efficient fashion. Availability of referral diagnostic modalities should not overshadow the need for collecting a clinical history or performing a complete physical examination. The diagnostic approach to exercise intolerance can be divided into a few basic steps. The first step, conducted without the horse, is a thorough discussion about the horse with the trainer and/or owner. Many clinical histories are complex and therefore following a predetermined pattern is helpful. Racing ability, general health history, historic problems with the major body systems including the musculoskeletal, respiratory, cardiovascular, and neurologic systems should be reviewed. The next step of the examination is conducted in the stall. A complete physical examination is required. The practitioner should pay close attention to the body systems that most frequently harbor causes of exercise intolerance. Before evaluating the horse for lameness, endoscopy of the upper airway should be performed. The final step is conducted outside the stall: completion of the lameness and neurologic examination or an exercise trial followed by further diagnostic tests such as a serum chemistry profile, bronchoalveolar lavage, or imaging studies. Decision for referral is best made after the physical examination is completed and capability for further diagnostics is exhausted.