Exercise-induced pulmonary hemorrhage: where are we now?

David C Poole,1,2 Howard H Erickson1 1Department of Anatomy and Physiology, 2Department of Kinesiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA Abstract: As the Thoroughbreds race for the final stretch, 44 hooves flash and thunder creating a cacophony of tortured...

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Autores principales:	Poole DC, Erickson HH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Epistaxis Thoroughbred racehorse pulmonary capillary rupture vascular pressure alveolar pressure nasal airway collapse Veterinary medicine SF600-1100
Acceso en línea:	https://doaj.org/article/21d70471d9264c598ef9b338a7114400
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spelling	oai:doaj.org-article:21d70471d9264c598ef9b338a71144002021-12-02T04:31:45ZExercise-induced pulmonary hemorrhage: where are we now?2230-2034https://doaj.org/article/21d70471d9264c598ef9b338a71144002016-11-01T00:00:00Zhttps://www.dovepress.com/exercise-induced-pulmonary-hemorrhage-where-are-we-now-peer-reviewed-article-VMRRhttps://doaj.org/toc/2230-2034David C Poole,1,2 Howard H Erickson1 1Department of Anatomy and Physiology, 2Department of Kinesiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA Abstract: As the Thoroughbreds race for the final stretch, 44 hooves flash and thunder creating a cacophony of tortured air and turf. Orchestrated by selective breeding for physiology and biomechanics, expressed as speed, the millennia-old symphony of man and beast reaches its climax. At nearly 73 kilometers per hour (45 mph) over half a ton of flesh and bone dwarfs its limpet-like jockey as, eyes wild and nostrils flaring, their necks stretch for glory. Beneath each resplendent livery-adorned, latherin-splattered coat hides a monstrous heart trilling at 4 beats per second, and each minute, driving over 400 L (105 gallons) of oxygen-rich blood from lungs to muscles. Matching breath to stride frequency, those lungs will inhale 16 L (4 gallons) of air each stride moving >1,000 L/min in and out of each nostril – and yet failing. Engorged with blood and stretched to breaking point, those lungs can no longer redden the arterial blood but leave it dusky and cyanotic. Their exquisitely thin blood–gas barrier, a mere 10.5 μm thick (1/50,000 of an inch), ruptures, and red cells invade the lungs. After the race is won and lost, long after the frenetic crowd has quieted and gone, that blood will clog and inflame the airways. For a few horses, those who bleed extensively, it will overflow their lungs and spray from their nostrils incarnadining the walls of their stall: a horrifically poignant canvas that strikes at horse racing’s very core. That exercise-induced pulmonary hemorrhage (EIPH) occurs is a medical and physiological reality. That every reasonable exigency is not taken to reduce/prevent it would be a travesty. This review is not intended to provide an exhaustive coverage of EIPH for which the reader is referred to recent reviews, rather, after a brief reminder of its physiologic and pathologic bases, focus is brought on the latest developments in EIPH discovery as this informs state-of-the-art knowledge, the implementation of that knowledge and recommendations for future research and treatment. Keywords: epistaxis, Thoroughbred racehorse, pulmonary capillary rupture, vascular pressure, alveolar pressure, nasal airway collapsePoole DCErickson HHDove Medical PressarticleEpistaxisThoroughbred racehorsepulmonary capillary rupturevascular pressurealveolar pressurenasal airway collapseVeterinary medicineSF600-1100ENVeterinary Medicine: Research and Reports, Vol Volume 7, Pp 133-148 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Epistaxis Thoroughbred racehorse pulmonary capillary rupture vascular pressure alveolar pressure nasal airway collapse Veterinary medicine SF600-1100
spellingShingle	Epistaxis Thoroughbred racehorse pulmonary capillary rupture vascular pressure alveolar pressure nasal airway collapse Veterinary medicine SF600-1100 Poole DC Erickson HH Exercise-induced pulmonary hemorrhage: where are we now?
description	David C Poole,1,2 Howard H Erickson1 1Department of Anatomy and Physiology, 2Department of Kinesiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA Abstract: As the Thoroughbreds race for the final stretch, 44 hooves flash and thunder creating a cacophony of tortured air and turf. Orchestrated by selective breeding for physiology and biomechanics, expressed as speed, the millennia-old symphony of man and beast reaches its climax. At nearly 73 kilometers per hour (45 mph) over half a ton of flesh and bone dwarfs its limpet-like jockey as, eyes wild and nostrils flaring, their necks stretch for glory. Beneath each resplendent livery-adorned, latherin-splattered coat hides a monstrous heart trilling at 4 beats per second, and each minute, driving over 400 L (105 gallons) of oxygen-rich blood from lungs to muscles. Matching breath to stride frequency, those lungs will inhale 16 L (4 gallons) of air each stride moving >1,000 L/min in and out of each nostril – and yet failing. Engorged with blood and stretched to breaking point, those lungs can no longer redden the arterial blood but leave it dusky and cyanotic. Their exquisitely thin blood–gas barrier, a mere 10.5 μm thick (1/50,000 of an inch), ruptures, and red cells invade the lungs. After the race is won and lost, long after the frenetic crowd has quieted and gone, that blood will clog and inflame the airways. For a few horses, those who bleed extensively, it will overflow their lungs and spray from their nostrils incarnadining the walls of their stall: a horrifically poignant canvas that strikes at horse racing’s very core. That exercise-induced pulmonary hemorrhage (EIPH) occurs is a medical and physiological reality. That every reasonable exigency is not taken to reduce/prevent it would be a travesty. This review is not intended to provide an exhaustive coverage of EIPH for which the reader is referred to recent reviews, rather, after a brief reminder of its physiologic and pathologic bases, focus is brought on the latest developments in EIPH discovery as this informs state-of-the-art knowledge, the implementation of that knowledge and recommendations for future research and treatment. Keywords: epistaxis, Thoroughbred racehorse, pulmonary capillary rupture, vascular pressure, alveolar pressure, nasal airway collapse
format	article
author	Poole DC Erickson HH
author_facet	Poole DC Erickson HH
author_sort	Poole DC
title	Exercise-induced pulmonary hemorrhage: where are we now?
title_short	Exercise-induced pulmonary hemorrhage: where are we now?
title_full	Exercise-induced pulmonary hemorrhage: where are we now?
title_fullStr	Exercise-induced pulmonary hemorrhage: where are we now?
title_full_unstemmed	Exercise-induced pulmonary hemorrhage: where are we now?
title_sort	exercise-induced pulmonary hemorrhage: where are we now?
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/21d70471d9264c598ef9b338a7114400
work_keys_str_mv	AT pooledc exerciseinducedpulmonaryhemorrhagewherearewenow AT ericksonhh exerciseinducedpulmonaryhemorrhagewherearewenow
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Exercise-induced pulmonary hemorrhage: where are we now?

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