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There exists an argument that the hearts of athletes are not en- tirely structurally and physiologically ‘normal’ but have adapted to high levels of stress put on them by training for intense exercise. It has been recognised that there are structural, functional, and elec- trical changes and remodelling of the heart in athletes (La Gerche et al., 2022 ). The increased capacity to pump the blood efficiently to the lungs and body is thought to possibly ‘overload the system’ and cause rupture of small pulmonary vessels leading to pulmonary haemorrhage. It has been shown that the stiffness of pulmonary ves- sels in Thoroughbred racehorses is greater than nontrained matched controls and this begs the question whether they are adapting that way as a result of the training or if the horses in training have a ge- netic predisposition (Blott et al., 2019 ). Since we know that almost all Thoroughbred racehorses will have evidence of pulmonary haemor- rhage at some point in their careers, it is interesting to reflect upon if this (EIPH) phenomenon may be more common in human athletes than is reported or typically considered. One report of a healthy, 26- year- old male marathon runner describes a case of subclinical EIPH (in a human athlete) after running marathons, however, no hae- morrhage was detected after periods of rest (Ghio et al., 2006 ). It was shown that the evidence of EIPH in this human athlete resolved with time, similarly to what is seen in equine athletes that rest and recover (Ghio et al., 2006 ). Often, bleeding is not detected at the nostrils of the horse, but
the horse may show signs of decreased performance, exercise in- tolerance, or respiratory compromise. EIPH can be scored clinically by utilising an endoscope to observe the upper airway and trachea for the presence of blood immediately following intense exercise. Scoring systems have been developed in Thoroughbreds to deter- mine the level of severity (Hinchcliff et al., 2005 ). Higher grades of bleeding with more blood present in the trachea (Figure 1 ) after ex- ercise is associated with shorter racing careers and it is possible that the disease progresses in severity if a horse continues to exercise at an intense level (Hinchcliff et al., 2015 ). In the case report by Kopec and colleagues, the gelding described was having poor performance
TOWNSEND
with EIPH and it is interesting to consider the possibility this gelding had an increase in severity of EIPH and progressive physical lung changes over time that predisposed it to the complications observed. EIPH remains a prominent problem and fascinating disease in equine (and human) medicine and there is much to be learned about how to best treat and manage these incredible athletes.
FUNDING INFORMATION No funding was received.
CONFLICT OF INTEREST STATEMENT No conflicts of interest have been declared.
ETHICS STATEMENT Not applicable to this clinical commentary.
ORCID Kile S. Townsend
https://orcid.org/0000-0001-8418-7842
REFERENCES
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FIGURE 1 Haemorrhage present in an equine trachea observed via endoscopy.
Hinchcliff , K.W. , Jackson , M.A. , Brown , J.A. , Dredge , A.F. , O ' Callaghan , P.A. , McCaffrey , J.P. et al. ( 2005 ) Tracheobronchoscopic assess- ment of exercise- induced pulmonary haemorrhage in horses . American Journal of Veterinary Research , 66 ( 4 ), 596 – 598 . Available from: https:// doi. org/ 10. 2460/ ajvr. 2005. 66. 596
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