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Fritz SA, Hall JO. Ionophores. Vet Clin North Am Equine Pract 2024; 40:161-166. [PMID: 37696707 DOI: 10.1016/j.cveq.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Ionophores are a class of polyether antibiotics that are commonly used as anticoccidial agents and growth promotants in ruminant diets. Ionophores transport ions across lipid membranes and down concentration gradients, which results in mitochondrial destruction, reduced cellular energy production, and ultimately cell death. Cardiomyocytes are the primary target in equine patients when exposed to toxic concentrations and the clinical disease syndrome is related to myocardial damage. Animals can survive acute exposures but can have permanent heart damage that may result in acute death at future time points. Animals that survive a poisoning incident may live productive breeding lives, but physical performance can be greatly impacted. Animals with myocardial damage are at risk of sudden death and pose a risk to riders.
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Affiliation(s)
- Scott A Fritz
- Department of Anatomy and Physiology, Kansas State University College of Veterinary Medicine, 1620 Denison Avenue, 228 Coles Hall, Manhattan, KS 66506, USA.
| | - Jeffery O Hall
- Cattle Technical Services, Huvepharma Inc., 525 Westpark Dr, Suite 230, Peachtree City, GA 30269, USA
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2
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Gy C, Leclere M, Bélanger MC, Allano M, Beauchamp G, Lavoie JP. Acute, subacute and chronic sequelae of horses accidentally exposed to monensin-contaminated feed. Equine Vet J 2020; 52:848-856. [PMID: 32145094 DOI: 10.1111/evj.13258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/16/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Monensin is highly toxic to horses and inadvertent ingestion can result in cardiac injury and death. OBJECTIVES To describe sequelae of monensin ingestion and to determine clinical predictors of outcome. STUDY DESIGN Observational clinical study. METHODS Physical examination, electrocardiogram and echocardiography were performed on 76 horses accidentally exposed to monensin-contaminated feed. Four horses were examined within 14 days of exposure (acute period), 29 horses were examined between 15 and 45 days post-exposure (subacute period) and 70 horses were examined 4-10 months after exposure (chronic period). Follow-up information was obtained for 56 horses by telephone interviews approximately 16 months after exposure. RESULTS Cardiac abnormalities were detected in 4/4, 19/29 and 31/70 horses during the acute, subacute and chronic periods, respectively. Sixteen months post-exposure, 34 of the 64 horses (53%) for which the outcome was known had returned to their previous use, 13 (20%) were reported to be exercise intolerant, three (5%) were retired and 14 (22%) were dead (two deaths, 12 euthanasia). Thinning of the myocardium observed at any point in time was associated with a negative outcome. Heterogeneity of the myocardium observed in the acute/subacute period was associated with a negative outcome while subjective contractile intraventricular dyssynchrony, cardiac chamber dilation, decreased fractional shortening and multiple premature ventricular complexes observed in the chronic period were associated with a negative outcome. Some horses with significant changes associated with a negative outcome in the chronic phase still returned to their previous work. MAIN LIMITATIONS No control group and only 27 horses were examined more than once. CONCLUSIONS Clinical outcome of horses exposed to sublethal doses of monensin is highly variable. The presence of heterogeneity and thinning of the myocardium shortly after intoxication were associated with a negative outcome.
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Affiliation(s)
- Clémentine Gy
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Mathilde Leclere
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Marie-Claude Bélanger
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Marion Allano
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Guy Beauchamp
- Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Jean-Pierre Lavoie
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
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3
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Pericardial Disease, Myocardial Disease, and Great Vessel Abnormalities in Horses. Vet Clin North Am Equine Pract 2019; 35:139-157. [PMID: 30871834 DOI: 10.1016/j.cveq.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pericardial, myocardial, and great vessel diseases are relatively rare in horses. The clinical signs are often nonspecific and vague, or related to the underlying cause. Physical examination usually reveals tachycardia, fever, venous distension or jugular pulsation, a weak or bounding arterial pulse, ventral edema, and abnormal cardiac auscultation such as arrhythmia, murmur, or muffled heart sounds. The prognosis depends on the underlying cause and the disease progression, and ranges from full recovery to poor prognosis for survival. This article focuses on the etiology, diagnosis, prognosis, and treatment of pericarditis, pericardial mass lesions, myocarditis, cardiomyopathy, and great vessel aneurysm or rupture.
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4
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Dembek KA, Hurcombe SDA, Schober KE, Toribio RE. Sudden death of a horse with supraventricular tachycardia following oral administration of flecainide acetate. J Vet Emerg Crit Care (San Antonio) 2014; 24:759-63. [PMID: 25388866 DOI: 10.1111/vec.12251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a case of supraventricular tachycardia and sudden death in a horse following administration of flecainide acetate. CASE SUMMARY An 8-year-old Hanoverian warmblood gelding was treated for chronic, naturally occurring, supraventricular tachycardia with digoxin, procainamide hydrochloride, quinidine sulfate, and flecainide acetate. After oral administration of flecainide, polymorphic ventricular tachycardia (torsades de pointes) and ventricular fibrillation developed, leading to cardiovascular collapse and death. NEW OR UNIQUE INFORMATION PROVIDED Atrial fibrillation is the most commonly diagnosed dysrhythmia associated with poor performance in horses, while atrial tachycardia is rarely documented. Here, we describe a case of sudden death in a horse with atrial tachycardia following the oral administration of flecainide acetate, after the lack of response to other antiarrhythmic drugs. Information provided in this case report is new and will make clinicians aware of the potential complications of flecainide alone or in combination with other drugs, in horses with cardiac dysrhythmias.
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Affiliation(s)
- Katarzyna A Dembek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
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Bautista AC, Tahara J, Mete A, Gaskill CL, Bryant UK, Puschner B. Diagnostic value of tissue monensin concentrations in horses following toxicosis. J Vet Diagn Invest 2014; 26:423-427. [DOI: 10.1177/1040638714523774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Two separate incidents of monensin exposure in horses resulting in toxicosis provided insight into the diagnostic value and interpretive criteria of various biological samples. In case 1, 25 horses broke into a shed and ingested feed that was supplemented with 800 g/ton (880 µg/g) of monensin. Within 48 hr, 1 horse had died, 2 developed cardiac arrhythmias, lethargy, and recumbency, and another was euthanized due to severe deterioration. Minimal histologic lesions were noted in the horse that died peracutely, while another showed characteristic lesions of acute cardiomyocyte degeneration and necrosis. Stomach content, heart, liver, urine, and serum revealed various detectable concentrations of monensin in clinically affected and unaffected horses with known exposure. In case 2, a pastured horse had access to a mineral mix containing 1,600 g/ton (1,760 µg/g) of monensin. Within 48 hr, the horse became symptomatic and was euthanized because of severe respiratory distress. Histologic cardiac lesions were minimal but detectable amounts of monensin were found in blood, heart, liver, and stomach contents. In both cases, monensin toxicosis was confirmed with toxicological analysis. These cases demonstrate an overall lack of correlation of monensin concentrations in various biological samples with clinical outcome. However, serum, urine, blood, liver, heart, and stomach content can be tested to confirm exposure. More importantly, the consistently higher concentrations found in heart tissue suggest this is the most useful diagnostic specimen for postmortem confirmation of toxicosis in horses especially in cases in which associated feed cannot be tested for monensin or in cases with no histologic lesions.
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Affiliation(s)
- Adrienne C. Bautista
- California Animal Health and Food Safety Laboratory System (Bautista, Tahara, Mete, Puschner), School of Veterinary Medicine, University of California, Davis, CA
- Department of Molecular Biosciences (Puschner), School of Veterinary Medicine, University of California, Davis, CA
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington KY (Gaskill, Bryant)
| | - John Tahara
- California Animal Health and Food Safety Laboratory System (Bautista, Tahara, Mete, Puschner), School of Veterinary Medicine, University of California, Davis, CA
- Department of Molecular Biosciences (Puschner), School of Veterinary Medicine, University of California, Davis, CA
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington KY (Gaskill, Bryant)
| | - Aslı Mete
- California Animal Health and Food Safety Laboratory System (Bautista, Tahara, Mete, Puschner), School of Veterinary Medicine, University of California, Davis, CA
- Department of Molecular Biosciences (Puschner), School of Veterinary Medicine, University of California, Davis, CA
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington KY (Gaskill, Bryant)
| | - Cynthia L. Gaskill
- California Animal Health and Food Safety Laboratory System (Bautista, Tahara, Mete, Puschner), School of Veterinary Medicine, University of California, Davis, CA
- Department of Molecular Biosciences (Puschner), School of Veterinary Medicine, University of California, Davis, CA
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington KY (Gaskill, Bryant)
| | - Uneeda K. Bryant
- California Animal Health and Food Safety Laboratory System (Bautista, Tahara, Mete, Puschner), School of Veterinary Medicine, University of California, Davis, CA
- Department of Molecular Biosciences (Puschner), School of Veterinary Medicine, University of California, Davis, CA
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington KY (Gaskill, Bryant)
| | - Birgit Puschner
- California Animal Health and Food Safety Laboratory System (Bautista, Tahara, Mete, Puschner), School of Veterinary Medicine, University of California, Davis, CA
- Department of Molecular Biosciences (Puschner), School of Veterinary Medicine, University of California, Davis, CA
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington KY (Gaskill, Bryant)
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Hepworth‐Warren KL, Alcott CJ. Treatment and resolution of zilpaterol hydrochloride toxicity in a
Q
uarter
H
orse gelding. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. L. Hepworth‐Warren
- Lloyd Veterinary Medical CenterCollege of Veterinary MedicineIowa State University Ames Iowa USA
| | - C. J. Alcott
- Lloyd Veterinary Medical CenterCollege of Veterinary MedicineIowa State University Ames Iowa USA
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Decloedt A, Verheyen T, Sys S, Clercq D, Loon G. Tissue Doppler Imaging and 2-Dimensional Speckle Tracking of Left Ventricular Function in Horses Exposed to Lasalocid. J Vet Intern Med 2012; 26:1209-16. [DOI: 10.1111/j.1939-1676.2012.00972.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/24/2012] [Accepted: 06/13/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- A. Decloedt
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - T. Verheyen
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - S. Sys
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - D. Clercq
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - G. Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
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8
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Nath LC, Anderson GA, Hinchcliff KW, Savage CJ. Serum cardiac troponin I concentrations in horses with cardiac disease. Aust Vet J 2012; 90:351-7. [DOI: 10.1111/j.1751-0813.2012.00970.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2012] [Indexed: 01/28/2023]
Affiliation(s)
- LC Nath
- Faculty of Veterinary Science; University of Melbourne; 250 Princes Highway; Werribee; Victoria; 3030; Australia
| | - GA Anderson
- Faculty of Veterinary Science; University of Melbourne; 250 Princes Highway; Werribee; Victoria; 3030; Australia
| | - KW Hinchcliff
- Faculty of Veterinary Science; University of Melbourne; 250 Princes Highway; Werribee; Victoria; 3030; Australia
| | - CJ Savage
- Faculty of Veterinary Science; University of Melbourne; 250 Princes Highway; Werribee; Victoria; 3030; Australia
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Decloedt A, Verheyen T, De Clercq D, Sys S, Vercauteren G, Ducatelle R, Delahaut P, van Loon G. Acute and Long-Term Cardiomyopathy and Delayed Neurotoxicity after Accidental Lasalocid Poisoning in Horses. J Vet Intern Med 2012; 26:1005-11. [DOI: 10.1111/j.1939-1676.2012.00933.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/23/2012] [Accepted: 03/10/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- A. Decloedt
- Department of Large Animal Internal Medicine
| | - T. Verheyen
- Department of Large Animal Internal Medicine
| | | | - S. Sys
- Department of Large Animal Internal Medicine
| | - G. Vercauteren
- Department of Pathology, Bacteriology and Avian Diseases; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - R. Ducatelle
- Department of Pathology, Bacteriology and Avian Diseases; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - P. Delahaut
- Département Santés animale et humaine; Centre d'Economie Rurale; Marloie; Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine
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10
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Dawson DR. Toxins and adverse drug reactions affecting the equine nervous system. Vet Clin North Am Equine Pract 2011; 27:507-26. [PMID: 22100042 DOI: 10.1016/j.cveq.2011.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article provides an overview of the more common toxins and adverse drug reactions, along with more rare toxins and reactions (Table 1), that result in neurologic dysfunction in horses. A wide variety of symptoms, treatments, and outcomes are seen with toxic neurologic disease in horses. An in-depth history and thorough physical examination are needed to determine if a toxin or adverse drug reaction is responsible for the clinical signs. Once a toxin or adverse drug reaction is identified, the specific antidote, if available, and supportive care should be administered promptly.
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Affiliation(s)
- Dominic R Dawson
- William Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, One Garrod Avenue, Davis, CA 95616, USA.
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11
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Heart disease in cattle: Diagnosis, therapeutic approaches and prognosis. Vet J 2010; 184:258-63. [DOI: 10.1016/j.tvjl.2009.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 03/05/2009] [Accepted: 05/03/2009] [Indexed: 11/23/2022]
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12
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Long‐term assessment of horses and ponies post exposure to monensin sodium in commercial feed. Equine Vet J 2010; 41:47-52. [DOI: 10.2746/042516408x330428] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Divers TJ, Kraus MS, Jesty SA, Miller AD, Mohammed HO, Gelzer ARM, Mitchell LM, Soderholm LV, Ducharme NG. Clinical Findings and Serum Cardiac Troponin I Concentrations in Horses after Intragastric Administration of Sodium Monensin. J Vet Diagn Invest 2009; 21:338-43. [DOI: 10.1177/104063870902100305] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Six adult horses were administered sodium monensin, 1.0–1.5 mg/kg, via gastric gavage. Anorexia and/or diarrhea occurred within 24 hr after monensin administration in all 6 horses. Cardiac disease and dysfunction were evaluated by both elevations in heart rate, echocardiography, and an increase in serum concentrations of cardiac troponin I (cTnI), occurred in 4 horses. The development and severity of cardiac disease was likely affected by the monensin dose, vehicle (water or corn oil) mixed with monensin, and/or whether the monensin was administered to fed or fasted horses. Initial increases in cTnI concentrations occurred between 24 and 72 hr after monensin administration. The 2 horses with the highest cTnI concentrations died or were euthanized within 5 days after monensin administration and had severe cardiac disease. One horse had increased cTnI concentrations from day 2 to day 16, but no apparent change in ventricular contractile function was evident on echocardiography. The fourth diseased horse did not return to cTnI reference intervals until day 27 after monensin administration, and the ventricular function was still abnormal just before euthanasia 9 months later. Cardiac troponin I measurements could be useful in managing farm outbreaks of accidental monensin feeding by the early identification of horses with cardiac disease.
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Affiliation(s)
- Thomas J. Divers
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Marc S. Kraus
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Sophy A. Jesty
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Andrew D. Miller
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Hussni O. Mohammed
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Anna R. M. Gelzer
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Lisa M. Mitchell
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - L. Vincent Soderholm
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
| | - Normand G. Ducharme
- College of Veterinary Medicine, Cornell Hospital for Animals, Cornell University, Ithaca, NY
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Frank N, Buchanan BR, Elliott SB. Effects of long-term oral administration of levothyroxine sodium on serum thyroid hormone concentrations, clinicopathologic variables, and echocardiographic measurements in healthy adult horses. Am J Vet Res 2008; 69:68-75. [DOI: 10.2460/ajvr.69.1.68] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
CASE DESCRIPTION A 4-month-old American Paint filly was evaluated because of sudden onset of ataxia that progressed to recumbency. Five additional horses from the same and neighboring premises developed signs of poor performance, generalized weakness, ataxia, and recumbency; 2 of those horses were also evaluated. A new batch of a commercial feed supplement had been introduced to the horses' diet on each farm within the preceding 3 days. CLINICAL FINDINGS Other than recumbency, findings of physical and neurologic examinations of the foal were unremarkable. The other 2 horses had generalized weakness and mild ataxia, and 1 horse also had persistent tachycardia. The foal had mild leukocytosis with neutrophilia, hyperglycemia, and mildly high serum creatine kinase activity. Results of cervical radiography, CSF analysis, and assessments of heavy metals and selenium concentrations in blood and vitamin E concentration in serum were within reference limits. Feed analysis revealed high concentrations of the ionophore antimicrobial salinomycin. TREATMENT AND OUTCOME The 5 affected horses survived, but the foal was euthanized. At necropsy, a major histopathologic finding was severe vacuolation within neurons of the dorsal root ganglia, which was compatible with ionophore toxicosis. The surviving horses developed muscle atrophy, persistent weakness, and ataxia. CLINICAL RELEVANCE In horses, ionophore toxicosis should be considered as a differential diagnosis for acute weakness, ataxia, recumbency, or sudden death. Furthermore, ionophore toxicosis should be considered as a cause of poor performance, weakness, muscle wasting, and cardiac arrhythmias in horses. Surviving horses may have impaired athletic performance.
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Affiliation(s)
- Monica Aleman
- Department of Medicine, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Diana A, Guglielmini C, Candini D, Pietra M, Cipone M. Cardiac arrhythmias associated with piroplasmosis in the horse: A case report. Vet J 2007; 174:193-5. [PMID: 16765620 DOI: 10.1016/j.tvjl.2006.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 04/10/2006] [Accepted: 04/10/2006] [Indexed: 11/25/2022]
Abstract
Cardiac dysfunction is a rare complication of babesiosis in domestic animals. The horse in this report showed clinical signs of anorexia, depression, fever, icterus and brown urine, and laboratory results (monocytosis, thrombocytopenia, azotemia, hyperbilirubinemia and bilirubinuria) indicated sub-acute piroplasmosis. Furthermore, junctional and polymorphic ventricular premature complexes and tachycardia associated with increased serum cardiac troponin I and myocardial-bound creatine kinase concentration were found. The diagnosis of piroplasmosis was confirmed by serology. Specific and supportive therapy for babesiosis allowed remission of clinical signs and laboratory profile abnormalities, including those of myocardial involvement. Myocardial damage associated with cardiac arrhythmia may be a complication of equine babesiosis as already demonstrated in other species.
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Affiliation(s)
- Alessia Diana
- Veterinary Clinical Department, Alma Mater Studiorum-Università di Bologna, Via Tolara di Sopra 50, I-40064 Ozzano Emilia (BO), Italy.
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