My horses nose is bleeding?

Question

My 16 yr old gelding nose started bleeding earlier today for no reason. It is not bleeding heavily and the blood is light red/dark pink in color. He has been acting really lethargic. Should i be worried? What could be the cause?

And it has been pretty cold for the last 2 weeks.

He is bleeding out both nostrils

Answer 1

He may be dehydrated and dry, causing him to have a nose bleed. Make sure he has lots of water and keep him as dehydrated as possible. If he's still having problems in a couple of days phone your Vet and get some professional advice. If it has already been going on for some time (the last day or two) seek your Vet's help immediately. He might have to have a IV injection just to get his hydrants up.

Answer 2

There are two reasons that your horses nose will bleed. First is that he gets a simple nose bleed from a blood vessel that breaks inside his nose, just like when you get a nose bleed. The other is that his lungs could have blood in them, or it could be coming from an internal trama injury. What you need to do is call out your vet asap and have your horse looked at. Even if you think its nothing I would hate for you to wake up tomorow with a dead horse. Call the vet and good luck.

Answer 3

If he is lethargic- get a vet ASAP. slowing down and internal bleeding are two very bad signs, if you mean that his nose is bleeding from up in the nasal passages.
If you mean it is on the outside he may have just scratched it. Lethargy is never good with any animal- any change in behavior should get checked out.

Phone calls to the vet are free!

Answer 4

It could be from a lot of stress, or being worked to hard, but not likely. I would call a vet now! and see what he says.

Answer 5

your horse could simply be a bleeder call your vet and have your horse checked there is a real good article about bleeders at horseheadquarters.com click on dallas doc

Answer 6

This could be a result of many things, most of them not good. Call a vet asap.

Answer 7

IS it reakky cold where you live? it could be cold weather that has dried out his sinuses. if he is lethargic call a vet.

Answer 8

I would call the vet and ask for his/ her opinion as to weather or not you should worry.

Answer 9

he might have a cold please give him / her a hug for me i just love horses

Answer 10

I think it may be due to cold weather if he is in a stall, the amonia from urine and mold from old hay make winter barn air dangerous. Here is some articles to help diagnose but a Vet is needed. Summary | Causes of heaves | Development of heaves | What heaves looks like | Special examination of the horse with heaves | Examination of the lung tissue from horses with heaves | Distinguishing heaves from other diseases | Control and management of heaves | Treatment of heaves | Prevention of heaves
Summary

Heaves or broken wind is a respiratory disease of horses resulting in signs of chronic coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds. These signs occur as the result of narrowing of the small airways of the lungs caused by: inflammation and thickening of their tissues; constriction of the smooth muscles that surround them; and accumulation of mucous and exudates within their lumens. The end result is trapping of air in the lungs (emphysema). Technically heaves is called chronic obstructive pulmonary disease (COPD). However, recurrent airway obstruction may be a better name because most cases go into remission when their environment is changed. Difficulty in breathing recurs when susceptible horses are again exposed to mouldy feeds or dusty conditions. Animals with clinical signs adopt a characteristic breathing strategy with very high peak flows at the start of exhalation which decreases rapidly as exhalation continues.

Causes of Heaves

Although heaves has been recognized as a disease of horses for centuries, its precise cause remains uncertain. Most published evidence suggests that the inflammation of the small airways (bronchiolitis) is the result of an allergic response that occurs following exposure of the lower airways to dust and moulds, particularly those that come from poorly cured hay.

Heaves occurs most frequently in the northern hemisphere (Europe and North America) among horses kept in stables. It also occurs in pastured horses in certain regions of Great Britain and the southern United States where it is thought to result from exposure to various pollens. Signs do not become obvious until a large number of airways are affected and therefore, many more horses are probably affected than is recognized. The disease is rare in warm dry climates and in New Zealand and Australia where horses spend little time in stables.

Common risk factors for the occurrence of clinical signs are exposure to poorly cured, mouldy or dusty feeds, confinement to a stable environment, inadequate stable ventilation, straw bedding and being 6 years of age or older. The incidence of the disease may be highest in ponies as they are frequently kept in less than ideal conditions and fed poor quality hay.

Other possible causes of heaves include specific toxins (3-methylindole) absorbed from the intestinal tract, exposure to cold air, genetic predisposition and viral respiratory infections. To date there is no solid evidence that any of these factors play a role in the occurrence of heaves but researchers are still exploring these theories.

Development of Heaves

Bronchiolitis (inflammation of small airways) is considered to be the most important abnormality of affected animals but spasm of the smooth muscles surrounding the bronchioles (bronchospasm) also plays a role. The airways of all horses become exposed to dusts, spores of moulds and a number of temperature resistant bacteria that are aerodynamically small enough (0.5-0.3 µm) to be inhaled deep into the respiratory system. However, the airways of horses with heaves are considered to be hypersensitive to these substances.

With the narrowing of the small airways of the lungs affected horses experience increasing difficulty in both pulling air into the lungs and pushing it back out again. As the condition advances, severely affected animals are seen to contract the muscles of the abdominal wall during the last phase of exhalation causing the floor of the abdominal wall to lift up at the very end of exhalation. This abdominal lift requires extra effort of some of the muscles of the abdomen. These muscles may enlarge visibly causing what is known as a "heave line".

Although there remains some dispute about it, the type of hypersensitivity occurring in these animals appears to be delayed rather than acute. Animals in remission and exposed to mouldy feeds take about 90 minutes to start developing signs of respiratory disease. The process begins with inflammation of the airways followed by thickening of their linings, accumulation of mucous and inflammatory debris, loss of the effectiveness of the mechanisms that normally remove mucous from the airways and spasm of the smooth muscles that are wrapped around the small airways. The end result is narrowing of thousands of tiny airways throughout the lungs and loss of the ability to ventilate the lungs fully and efficiently. Affected lung tissue looses its normal elasticity and this combined with narrowing of the airways prevents normal ventilation and oxygenation of the lungs. This process results in poor oxygenation of the blood and subsequent loss of exercise tolerance and poor performance.

An other consequence of this condition may include so called bleeders or "exercise induced pulmonary haemorrhage". This is thought to occur as the result of laboured breathing with marked pressure differences developing across the delicate tissues of the lung and their tiny blood vessels. Bleeding may result when these pressure differences become so large that blood vessels start to rupture and blood escapes into the airways occurs.

With narrowing of the small airways it becomes increasingly difficult for affected horses to push the normal volume of air out of the lungs at the end of exhalation. As a result, the lungs tend to remain over-inflated at the end of exhalation resulting in a condition known as functional or reversible emphysema. In some cases, the disease progresses to the point that permanent, non-reversible damage in at least some portions of the lung tissue. There is no quick and reliable method of determining if this has occurred, although persistent failure to respond to treatment and management of the disease and the examination of lung biopsies may point in this direction. In many cases, much of the loss of lung function that occurs in cases of heaves is reversible with the aid of careful management of the animal and its environment.

What Heaves Looks Like

Horses do not usually show signs of heaves until they are 6 years of age or older. The earliest clinical signs are coughing at exercise, when eating or when exposed to dusty environments. The respiratory rate begins to increase from the normal of 8-12/min to 24-36/min and this is accompanied by an increase in the depth of respiration. As breathing becomes more difficult, a distinct lift of the floor of the abdomen will be observed at the end of exhalation and the nostrils will begin to flare during inspiration. By placing your ear close to the nostrils you may detect a wheezing sound as the horse breaths. Intermittent nasal discharge composed of mucus and pus (mucopus), evident in both nostrils, is a common sign. The quantities of this material may be quite large when the horse puts its head down to eat after having had it tied above the ground for 2 or 3 hours. Following exercise the heart rate will be faster than expected and after vigorous exercise, some blood may be evident in the nasal discharge. With the aid of a stethoscope, wheezing and crackling sounds may be heard over the lung fields and fluid, fluttering sounds may be heard in the trachea. The abnormal lung sounds are easiest to detect if the horse is made to take deep breaths with the aid of a rebreathing bag or following exercise. These abnormal sounds are caused by the accumulation of mucopus in the respiratory tract and the narrowing of airways in the lungs. In the most advanced stages of the disease, horses lose weight and appear in severe respiratory distress with marked flaring of the nostrils and abdominal breathing. There may also be an obvious accentuation of the spaces between the ribs associated with extreme efforts to breath.

The course of the disease depends largely on the degree of effort that is put into improving the conditions under which the horse is kept. Complete or near complete recovery from the signs has been reported in horses turned out to pasture or by moved into a well ventilated stall, fed cubed or pelleted roughage with dampened grain, and kept on bedding that is virtually dust and mould free, such as shredded paper or high quality wood shavings.

In summary, the important indication of heaves in the horse are:

1. Horses older than 6 years of age
2. Prolonged or repeated stabling or exposure to other dusty environments
3. Having a chronic cough and reduced exercise tolerance
4. Difficulty breathing in an otherwise healthy animal
5. Wheezing and crackling lung sounds heard with a stethoscope
6. Laboured breathing (abdominal lift, flaring nostrils) in horses at rest
7. Worsening of clinical signs when the horse is exposed to poor quality feeds or environments
8. Improvement or remission of clinical signs when the horse is kept at pasture or in a near dust free environment and fed a cubed ration for 7-21 days

Special Examination of the Horse With Heaves

The results of a complete blood count and serum biochemistry tests are usually normal in horses with heaves. The principle abnormality detected by blood tests is a decrease in oxygen content of arterial blood from the normal of about 77 mm/hg to about 61 mm/hg.

Lung function tests have been used in the study of heaves but the equipment required to perform these tests is highly specialized and only available in a few laboratories. The results of pulmonary function tests have shown that horses with heaves have distinct changes in air flow rates, decreased elasticity of the lung tissues and increased resistance to the flow of air in the airways.

The examination of fluid samples obtained from the trachea (tracheal or trans-tracheal aspirates) is also useful in making the diagnosis of heaves. With the aid of a flexible endoscope passed through the nasal cavity and down the trachea, large quantities of mucopus may be observed in the lower part of the trachea. Samples of this fluid contain large numbers of white blood cells, largely as a result of an increase in the number of neutrophils.

Techniques have also been developed to permit sampling of the region of the small airways. The technique, bronchoalveolar lavage (BAL), is performed by passing an endoscope or a specialized BAL tube down the trachea and pushing it until it lodges in a small airway. Collection fluid is injected down the tube, flooding a small portion of the lung and then withdrawn and submitted to the laboratory. The cells suspended in the fluid are then concentrated and examined under a microscope.

In some cases, lung biopsies may be taken in an effort to determine if permanent changes have occurred in the lung tissue. Radiographs taken of the chest when clinical signs are severe may show an increase in lung density associated with the infiltration and thickening of the airways by inflammatory cells. If there is a history of bleeding with exercise then radiographs may show a marked increase in the density in the upper part of the lung field. In specialized research facilities, nuclear scintigraphy or imaging has been used to further characterize these lesions.

Examination of the Lung Tissue From Horses With Heaves

Heaves is not usually a fatal disease so there are few published studies upon the examination of lung tissue from affected animals. The information that is available confirms that the major lesion is bronchiolitis (inflammation of airways with a diameter of 2 mm or less) and emphysema (trapping of air in the lung). There are plugs of mucus in the bronchioles, a build up of fibrous tissue around the airways (peribronchial fibrosis) and infiltration of the tissues surrounding the bronchioles with inflammatory cells (white blood cells). In the large airways there is evidence of loss of the ciliated epithelial cells which are important in moving secretions up the trachea and out of the lungs. With the exception of the peribronchiolar fibrosis and the destruction of some of the fine membranes or alveoli that occurs due to severe emphysema, most of the lesions observed in the lungs of horses with heaves are reversible in nature.

Distinguishing Heaves From Other Diseases

Heaves can be confused with other diseases including severe bacterial pneumonia, pleurisy, parasitic pneumonia (lung worm infections), certain neoplasms or cancers of the thoracic cavity and diaphragmatic hernia. Distinguishing these diseases from heaves is accomplished through careful physical examination of affected animals. In general, horses suffering respiratory distress due to diseases other than heaves look very ill, depressed and/or painful. Many animals with these conditions suffer a sudden loss of appetite and have distinct abnormalities in their complete blood counts. The diagnosis these diseases may be aided by radiographic or ultrasonographic examination of the thorax.

Control and Management of Heaves

It is well recognized that the best treatment for heaves is to remove the animal from the environment that appears to be causing the problem and by reducing exposure to dusts and moulds. Unless every reasonable effort is made to meet these objectives, none of the other recommended treatments is likely to be effective. In experimental studies, horses suffering from acute signs of heaves, subsequent to exposure to mouldy feeds, experience substantial remission of clinical signs one to three weeks after being moved to a dust free environment and fed cubed roughage.

Where practical, the best approach to management is to keep susceptible horses in the open air. Many owners are reluctant to keep horses outside during cold weather but there is ample evidence to show that horses, in good bodily condition, given adequate nutrition, a good windbreak and overhead shelter do very well in our cold, dry climate. Attempting to keep horses with heaves indoors requires well ventilated stalls bedded with shredded paper, peat or high quality shavings. Some of these cases can be managed by feeding high quality hay that has been thoroughly soaked prior to feeding; others require a cubed or pelleted ration. Feeding horses on the ground may assist in draining inflammatory exudates collected in the trachea.

Treatment of Heaves

Many drugs have been used in the treatment of heaves. Unfortunately, although most veterinary practitioners and horse owners believe that at least some treatments are beneficial, there is very little published scientific evidence to support this view or to allow us to compare the effects between treatments. Most modern treatments for heaves centre around the use of drugs to decrease the amount of inflammation and the accumulation of inflammatory exudate in the respiratory tract, to dilate the airways, and to increase the rate of clearance of mucus and inflammatory debris from the respiratory tract. Drugs used to decrease inflammation include corticosteroids such as dexamethasone or prednisolone, administered over a period of one to three weeks. A whole variety of bronchodilators have also been used, including atropine and clenbuterol. Traditionally, most of these treatments have been given by injection or by mouth. More recently there has been a move towards the administration of corticosteroids and bronchodilators as inhalants and special devices are now on the market that permit the use of products that have been developed for use in the treatment of asthma in humans.

Prevention of Heaves

In those parts of the world where horses are kept out of doors and grazed most of the year, heaves rarely occurs. On the other hand, heaves is common in those regions where horses are kept in stalls, bedded on straw and fed hay. Hay baled at 15-20% moisture and carefully stored will contain little dust and few spores. Horses fed this sort of roughage, all of their lives, should have few problems with heaves. On the other hand, hay baled with a moisture content of 20% or greater may become contaminated with the types of moulds that have been shown to result in the acute onset of clinical signs of heaves. The higher the moisture content of the hay when bailed, the greater the risk and degree of contamination.

The period of exposure to moulds required to initiate the first clinical signs of heaves is not known. However, it is clear the safest and most logical approach to the prevention of this disease would be to limit exposure to those feeds and conditions that are known to cause acute signs in susceptible animals. Further, these management procedures should be initiated at birth rather than after signs of the disease have developed.

Dr. H. G. G. Townsend is on the faculty at W.C.V.M. and part of the Equine Respiratory Research Group. He has done extensive research on respiratory problems in race horses in Western Canada. He is internationally recognized for his knowledge on respiratory problems in horses and much of the research has been funded by the W.C.V.M. Equine Health Research Fund.

This information was presented at, and appears in the Proceedings of, the 1998 Alberta Horse Breeders and Owners Conference.

This information is maintained by of the Horse Industry Section of Alberta Agriculture in conjunction with Sylvia Schneider at Pondside Web Productions.

Dr. H.G.G. Townsend
Western College of Veterinary Medicine
University of Saskatchewan


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For more information about the content of this document, contact Les Burwash.
This information published to the web on March 13, 2002.
Last Reviewed/Revised on September 13, 2006.

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