Atrial Fibrillation and heart murmur - what to do?

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zoon

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I have a bit of a dilemma and wanted some advice, especially from any vets on here.

My horse has a grade 5 aortic murmur. He is checked yearly by Leslie Young and until now was deemed no more likely than any other horse of his age (he is 16) to die of sudden death. He is fit, in perfect condition and currently in full work doing dressage and showjumping. He has just returned from his yearly trip to see Leslie. When there he will have a doppler ultrasound and his heart monitored during exercise.

This year, the ultrasound showed his heart had increased from 14.5cm diameter 2 years ago (he missed a check last year) to 16cm this year, which is showing that his heart is beginning to struggle, although the murmur is no worse.

For his exercise test, he canters/gallops 14 furlongs (approx 3 km) depending on his fitness that year - this year I had no choice but to gallop as he is feeling very well at the moment! In the 8th furlong, he went into atrial fibrillation. This was only noticed when his heart was listened to that evening (his exercise test was at about 1pm) and it was confirmed later when viewing the trace when he went into AF. He spontaneously reverted to sinus rhythm the next morning.

Leslie tells me he was in no pain or discomfort and would only have felt tired due to the AF. It may or may not occur again, but fast work will stress the heart and may bring it on. I have a stethoscope to monitor his heart. If it occurs again and does not spontaneously revert to sinus rhythm in 24hrs then I need to contact her straight away -she did not mention what it would mean, but I can guess. Due to the murmur I would not put him through quinidine treatment.

Her advice to me is to continue as we are if I feel safe to do so - he is now at a greater risk of sudden death due to the enlargement of his heart and therefore there is a risk to me. She says this risk cannot be quantified, but obviously she would not advise me to continue riding if the risk was in any way significant.

He has issues keeping weight on, especially over winter, and his current regime is keeping him in fabulous condition -

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If he is retired, I will not be able to justify the cost of keeping him on full livery (which I need due to work and my son) and will not get through a winter out at grass (he was turned away to grass last winter with ad lib hay, good hard feed and good rugs due to me having a baby and it took a lot of time and effort to get him looking good again), so basically if he is retired, he will spend the summer and autumn muching away to his hearts content and then be PTS before winter.

My problem is that I not sure whether to continue riding him. I am not worried about the risk to myself, I am more worried about causing him stress or discomfort or working him harder than I should for the health of his heart for my own pleasure. He currently seems happy as larry, although tonight he seemed to sweat up quite quickly, which is again making me think he is not up to it - we only did a brief schooling session on the flat.

Can anyone give me any sort of advice that can help me get this huge amount fo info sorted in my head and maybe help me make a decision???
 
I have had a horse die under me with heart failure and he nearly killed me. I also have a husband who had atrial fibrillation and an enlarged heart due to an aortic murmur ten years ago and he was told quite categorically by his consultant to stop running or he risked sudden death at any time. He was told a month ago that in humans, atrial fibrillation also increases the risk of blood clots blocking arteries and inducing a heart attack that way. I don't know if that applies to horses. He also tells me that the atrial fibrillation can clearly be felt and for a human is quite frightening. It also made him feel dizzy, disconnected mentally, sick and if he did not sit down he would have fallen down. If your horse's aortic murmur is due to a faulty valve, then I can tell you that if he was human and experiencing this deterioration it would continue until you see him obviously failing, and in a human that was not pleasant to watch or to experience.

My experience with my horse (burst aorta) is that you may not know there is a thing troubling him until he drops dead, and that's likely to be when his heart is stressed, and that's likely to be when you are on him.

Please don't take the risk of riding your horse, he could easily kill you. He is gorgeous but I really think that you need to let him go :(
 
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See, that's what I would have decided, but the leading equine cardiologist is telling me to do otherwise
 
zoon said:
See, that's what I would have decided, but the leading equine cardiologist is telling me to do otherwise
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That's easy for him to say, he's not on his back and presumably he doesn't have the condition himself?

I was knocked out for over an hour and concussed and lucky to be alive when my horse, the size of yours, died under me after a lovely canter out on a hack.

And my husband, if you'd like to talk to him, can tell you in words your horse can't use, exactly what it felt like to have a failed aortic valve, enlarged heart and atrial fibrillation, can your equine cardiologist speak for your horse? Would they have cut my husband's heart in half and sewn in a mechanical valve if they didn't need to do it to stop him dying suddenly at any moment?

The risk to your life is not worth it.

The risk of him suffering quietly, mentally or physically, and being unable to let you know is not worth it. Did your cardiologist tell you that he will die of multiple organ failure as they shut down one by one due to an inadequate blood supply if he does not suffer sudden death?

Give him the dignity of a quiet peaceful death, not dropping dead on a hillside and being dragged away by one leg chained to a tractor, which was what happened to mine :(

You have all my sympathy, it's a horrible decision when he looks so superb.





ps I added to my last post while you were posting so you might want to read it again.
 
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A friend of mine had her 4* diagnosed with a similar problem. He suffered loss of performance, which they thought was a virus, and found the enlarged heart upon examination. Even though the horse was up to that point in heavy work, my friend did not ride him again (she was lucky enough to have her own place to retire him) in part because of the risks involved. I know you say you're not concerned but a) will you still be able to say that now you know a bit more what the real situation is and b) no offence, but you have your son to consider, too. It's one thing to take on the "regular" risks of riding, it's another to up the odds.

I have ridden a couple of horses with seizure disorders (I know, not the same thing, but similar risks) and, oddly, each time the specialists involved have encouraged the owners to keep riding the horses. In one case the owners didn't tell me the whole story and the horse's regular vet called me - totally unprofessional but I was very grateful - to tell me in no uncertain terms that he was not at all keen on me riding the horse.

I did see a mare with a known heart condition die. To be fair, it was fairly obvious something bad was happening but not a lot of time elapsed between the horse showing symptoms and the moment she collapsed, nor did she get steadily worse - she was basically fine, she was in distress, then she fell over. I've seen a few others "die on their feet" and it's not pretty. :(

He looks and sounds a lovely fellow and I'm very sorry for your situation. But, as above, you have the chance to give him a peaceful death while he's still relatively healthy. It does sound like you'll have the same decision to make at some point, anyway but in this case, I really would say better a day too early than too late. Very sad.
 
So sorry :(

I cannot give you any advice, just tell you my experience, I lost my horse to AF just over a year ago.

I first noticed a change in him when he stopped being so strong, he had always been a horse with two paces, walk and flat out! At first I just put it down to the fact that he was getting older (he was 17 at the time), but a few weeks later he struggled to keep up with the field out hunting, so I got the vet out and he diagnosed AF with an ECG.

I looked into the quinidine treatment but decided it was out of the question, high risk, highly unpleasant with only a small chance of success. I pottered about on him for a while, just hacking and we only did what he was happy and comfortable doing. The last time I rode him, he set off at a marching pace as he always did but was so pooped on the way home (only road work at a walk) that I dismounted and led him, I never rode him again. He did less well than he had done before the AF and took a fair bit of feeding over his last winter, but it was not the winter that finished him off. The very first hot weekend we had he went into heart failure (his legs swelled and he was very sleepy and lethargic) and I arranged to have him PTS ASAP as I didn't want him to get to the point of callapse. The day before, to look at him you wouldn't have known there was anything wrong with him.

ETA, Foraday on here had a horse with AF that she was still riding at the time that mine was diagnosed, and she was sooo helpful and gave me loads of advise, drop her a PM.
 
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My IdxTB was diagnosed with A-Fib several years back, it happened rarther suddenly however we couldnt pinpoint if the AF had happened at that time. He basically started acting very strange in the field & then would not eat anything.

Vet diagnosed AF & he was sent down to Mark Patterson to have the quinidine treatment. He had an Ultrasound & also had ECG machine fitted for 24hrs prior to the treatment.
During the 24hr ECG it was found that he also had very severe Tachycardia, it was at this point i was told he would never be ridden again due to the high possibility of sudden death.

The Quinidine treatment went ahead but failed & we brought him home, he continued not to eat for 7 days. All we could get down him was carrots.

He's been fully retired ever since, he's still in AF & it is possible to see it. He seems very happy & occasionally he will have a bad week & stop eating again. But i can normally bring him round within a few days but it's very worrying.

I cant give you any positives on the riding front because they really can feel AF. My mum suffers it & what Cptrayes says is right.
 
He is not currently in AF - he went back to sinus rhythm spontaneously. I obviously wouldn't ride him if he was in AF! His heart rhythm is currently totally normal.

The risk of him going back in to AF is now increased, but Leslie said it may never happen again so treat him as a normal horse, but be aware of the signs so I know if it has occured again - I have a stethoscope to check. If it does happen again he wouldn't be able to go through the quinidine treatment as he has a murmur so he'd need to be retired for the summer as I said.

I am just worried about him going back in to AF and am wondering if it is worth all the worry
 
zoon said:
He is not currently in AF - he went back to sinus rhythm spontaneously. I obviously wouldn't ride him if he was in AF! His heart rhythm is currently totally normal.

The risk of him going back in to AF is now increased, but Leslie said it may never happen again so treat him as a normal horse, but be aware of the signs so I know if it has occured again - I have a stethoscope to check. If it does happen again he wouldn't be able to go through the quinidine treatment as he has a murmur so he'd need to be retired for the summer as I said.

I am just worried about him going back in to AF and am wondering if it is worth all the worry
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It's a hard one & because the specialist hasnt ruled out continued work it sort of makes it harder for you.

The thing is you have already said you cant retire him so he would be PTS, so i cant see why you would continue riding him especially if the specialist has said to continue.

The AF may or may not happen again, if i was in your position i would probably not want to do lots of fast work with him. The fact that the AF corrected it's self is a good thing BUT it may of been the stress on him galloping that caused it as he already has an enlargement of his heart. The enlargment in its self does mean that the heart is under some stress to function properly as the muscles of the heart do not enlarge otherwise.
 
I'm sorry but this 'if he was retired I could not afford to keep him on full livery' lark is a bit rich, he has been a faithful servant and it is quite unkind to suggest PTS because you would not get as much value for your money.
Is there any value in decreasing the work he does to prevent the stress on the heart? Have you discussed that with the vet? Are you hastening his demise by competing him? I'm afraid none of us can really advise when you sound like you have an excellent vet on hand.
 
'Give him the dignity of a quiet peaceful death, not dropping dead on a hillside and being dragged away by one leg chained to a tractor, which was what happened to mine ' No matter what happens your horse will generally be dragged away attached to a tractor for practical reasons.. And dropping dead is certainly not what a lot of us would call an unpleasant way to go... It is also quite difficult to say that the horse is feeling what a human is feeling, horses are realtively easy to read for their keepers, are they dull, depressed, not as forward int hier walk to their stable etc. and I would argue a regular keeper/rider tends to know if they trust their instincts if a horse is feeling a bit rubbish..
 
OP try and ignore SusieT if you can. You'd see if you check her previous posts that she enjoys posting to contradict advice that I give people. She doesn't seem to me to be helping you one bit with her posts.

Susie do you want to ride a horse that has a problem which can, and does, cause sudden death?

Have you been on a horse when it dropped dead? Not when it got a heart attack and staggered to its death, but when it died precipitately under you and pile-drove you into the dirt as it fell like a stone from 17 hands up?

I suggest you try it before you start recommending this poor girl to put her life at risk like that.


I bow to your greater experience, though, Susie, if it is normal in your world to see a horse corpse dragged half a mile by tractor to get it to the road where the meatwagon could reach. I've only seen it once and I never want to see it again.

I'd also repeat that if this horse does not drop dead or be put down, then it will die of progressive organ failure from an inadequate blood supply. The enlargement of the heart means that this process has already started. I wouldn't risk my own life riding a horse which could drop dead at any moment, and I wouldn't put a horse I thought highly of through organ failure, which makes humans feel bl**dy awful long before it becomes life threatening.
 
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Leslie Young is one of the most eminent equine cardiologists in the country. OP, I'd take her advice, particularly as you have invested so much in monitoring your horse over the years. I'm sure she will not mind discussing your concerns with you further. Remember that, at the end of the day, she really doesn't want to be responsible for your horse falling on you, so I'm sure she would advise against riding him were she in any doubt whatsoever.

Secondly cardiac sudden death in horses is generally not associated in any way with pre-existing heart problems, so whilst I sympathise with your experience CPTrayes, I do feel that your account is more scare-mongering that relevant. Equally, I have never seen a horse die of multiple organ failure as a result of heart disease, as they give their owners ample opportunity to put them to sleep before they reach the end.

I agree that conversion into AF can be disconcerting for horses, but there are quite a lot of horses competing in dressage and even SJ that are permanently in atrial fib and don't seem bothered by it. Also OP remember, (as I'm sure Leslie told you) a lot of horses throw funky rhythms following hard exercise, and the significance of this is not well understood.

At the end of the day, your vet has given you the best advice she can having measured your horses heart function as accurately as possible. I can understand that sometimes it is easier to make a decision on these matters rather that waiting for the inevitable. The flip side is that your horse will almost certainly let you know when his heart is not working as well as he needs it to, by being less keen to work and taking longer to recover afer periods of exertion. You can only do what you feel is right for him and you.

Hope that is of some help.
 
Thanks guys.

SusieT - I don't think I have to justify my decisions for his retirement. I'd rather he was pts after a summer stuffing his face (his favorite thing to do!) and looking his best than struggle through each winter and only just coming out the other side. I don't think that is letting him go with much dignity, do you?
 
Hoptoit said:
Secondly cardiac sudden death in horses is generally not associated in any way with pre-existing heart problems,
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This should surely read
"Secondly cardiac sudden death in horses is generally not associated in any way with KNOWN pre-existing heart problems"??

Most horses are not post mortemed after death. I have seen two die in the hunting field and their owners had never had their hearts checked, as most owners never have their horses hearts checked. Hearts just don't stop for no reason, generally.

Hoptoit said:
so whilst I sympathise with your experience CPTrayes, I do feel that your account is more scare-mongering that relevant.
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I live with a human who has the exact condition this horse has, and can tell me exactly how it has felt for the last ten years as he gradually failed. I understand that your sympathy is genuine but my experience is directly relevant.

How is it scaremongering when the expert vet has advised the owner that the horse is at an increased risk of sudden death? She's given the advice and then left it with the owner to decide whether the horse is safe to ride or not. She's safe from being sued, isn't she, and she is not the one on top of the horse taking the risk. Yes it's a calculated risk, but it's bigger than normal and riding is risky enough as it is. I know I wouldn't ride that horse and I'll get on anything normally.


Hoptoit said:
Equally, I have never seen a horse die of multiple organ failure as a result of heart disease, as they give their owners ample opportunity to put them to sleep before they reach the end.
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And none of those owners know how their horses were really feeling, as they cannot speak, and horses, being preyed upon animals, go to a lot of effort to hide their weaknesses so as not to be the one that gets eaten. My husband looks fine but he has felt like dreadful and suffered periodic vascular dementia as his brain failed to get enough oxygen to let him think properly for more than two years until his aortic valve was replaced a month ago.

It took me a year to find a vet who would do a proper set of tests on a horse I had who was eating more than I thought he should need. None of the ones I used would believe me that he was ill, because of his shiny coat and lack of symptoms. I rode him one day, had a blood test result for kidney function the following day and he was put to sleep for almost total kidney failure on the third day. We don't know how our horses struggle sometimes, they don't always tell us.

Hoptoit said:
I agree that conversion into AF can be disconcerting for horses, but there are quite a lot of horses competing in dressage and even SJ that are permanently in atrial fib and don't seem bothered by it. Also OP remember, (as I'm sure Leslie told you) a lot of horses throw funky rhythms following hard exercise, and the significance of this is not well understood.
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It's not the rythmn that bothers me so much, it's the enlargment of the heart, which is indicating that the heart is struggling now, with the work that the OP normally does. The fact that it went into AF under an abnormal exercise load is not a surprise, but the day to day work is already causing it strain. When my husband's heart enlarged in a similar fashion for the same reason he was directed to give up running to keep himself fit immediately, the other choices being die suddenly or have a pacemaker fitted. A pacemaker is not an option for this horse, but death with a rider on top is!

Hoptoit I can see where you are coming from, truly, but there are worse things for this horse and his owner than for him to be put down this year instead of the owner watching a steady decline of a wonderful horse who becomes more and more of a danger to ride, surely?
 
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CPtrayes always speaks sense. We were out on a hack and on the way home my boy went sluggish going uphill. However he was a funny old so and so , one minute pulling your arms out the next he would would be a plod. I thought it a bit odd but we carried on home. Got him in the stable tack off and he dropped like a stone...was as if he knew he had to get me back. No he didn't die, with hindsight we should have had him PTS, but we gave him a chance he was on large doses of Digoxin, recovered and I started to hack him quitely. Then he went off, just wasn't right, he had AF. We had him PTS straightaway and he went off to hunting field in the sky.

Don't know whether you saw the cancer post on NL, but my experience has meant that I realise there is no substitute for human life. A horse or dog can be replaced but not a human. Don't take the risk, have him PTS, however much you will miss him he can be replaced......your life can't
 
Hello there,

I have only just come across this thread. I do not know what has happened to your horse but if yOu still have him feel free to pm me about af.

I have a showjumper that has had the condition for nearly five years, and has been treated twice. I also had Mark pateson to scan and treat and give prognosis. I have owned this horse for 9 years and can give some reassurance and experience of the problem- I am very conversant now in my horses cardiology!

I have to say the af in horses is completely different than in humans. Aortic valve insufficiency and chf are a whole different ball game.

My horse lives life to the full after a steady four years, working out what work he can do. Pm me if you need to. He has been a bs jumping horse his whole life x
 
I have nothing much to add other than a rather useless 'I'm very sorry about your predicament' statement.

I had a horse drop down dead with a heart attack, his was rather like Hickstead, Eric Lamaze's horse that died the other day. My partner has seen horses drop down dead whilst competed on the XC course where he works and he said it was very very quick. On each ocassion the rider was not hurt and thrown well clear, but I understand you have as much risk of a horse landing on you as not.

Best wishes xxxx
 
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