🔥 Vet’s 2025 Guide to Equine Malignant Hyperthermia

By Dr Duncan Houston BVSc

1. What Is Malignant Hyperthermia?

Malignant hyperthermia (MH) in horses is a rare, life-threatening genetic syndrome that causes a hyper‑metabolic crisis. Triggered by anesthesia agents, stress, or excitement, MH causes rapid calcium release in muscle cells leading to extreme muscle rigidity, high fever, dangerously fast heart and respiratory rates, and often fatal outcomes if untreated :contentReference[oaicite:3]{index=3}.

2. What Causes It?

• Genetic mutation: Autosomal dominant mutation in the RYR1 gene (C7360G, R2454G substitution), found primarily in Quarter Horses and related breeds :contentReference[oaicite:4]{index=4}.
• Abnormal calcium control: Faulty ryanodine receptor releases excess calcium during triggers, causing sustained muscle contraction and heat generation :contentReference[oaicite:5]{index=5}.

3. Who's at Risk?

• Quarter Horses, Paints, and related breeds :contentReference[oaicite:6]{index=6}.
• Susceptible horses may carry one or two copies of the mutation — genetic testing identifies affected vs. unaffected individuals :contentReference[oaicite:7]{index=7}.

4. Common Triggers

• Volatile anesthetics: halothane, isoflurane, sevoflurane :contentReference[oaicite:8]{index=8}.
• Depolarizing muscle relaxants: succinylcholine :contentReference[oaicite:9]{index=9}.
• Rare triggers: stress, excitement — possible anesthesia-free episodes :contentReference[oaicite:10]{index=10}.

5. Recognising an MH Episode

• Sudden muscle rigidity, especially jaw/masseter muscles :contentReference[oaicite:11]{index=11}.
• Rapid rise in body temp (>40 °C), tachycardia, tachypnea, profuse sweating :contentReference[oaicite:12]{index=12}.
• Irregular heart rhythm, metabolic acidosis, hyperkalaemia, myoglobinuria :contentReference[oaicite:13]{index=13}.
• Signs may mimic severe tying-up, colic, or heat stroke — but the trigger and speed of presentation are key :contentReference[oaicite:14]{index=14}.

6. Diagnosis & Genetic Testing

• Clinical suspicion: diagnosis often made during anesthesia or acute crisis :contentReference[oaicite:15]{index=15}.
• Genetic testing: UC Davis Veterinary Genetics Lab offers MH mutation screening—hair or blood sample for Quarter Horses and related breeds :contentReference[oaicite:16]{index=16}.

7. Immediate Management

• Stop triggering agents: discontinue anesthesia or caffeine sources immediately :contentReference[oaicite:17]{index=17}.
• Administer dantrolene: 2.5–4 mg/kg IV to block calcium release :contentReference[oaicite:18]{index=18}.
• Supportive care: aggressive cooling with ice and alcohol, chilled IV fluids with sodium bicarbonate, oxygen therapy, and mechanical ventilation if needed :contentReference[oaicite:19]{index=19}.

8. Preventing MH Episodes

• Genetic screening prior to breeding or anesthesia in risk breeds :contentReference[oaicite:20]{index=20}.
• Avoid volatile anesthetics and succinylcholine in susceptible horses; use septic protocols and consider dantrolene pretreatment :contentReference[oaicite:21]{index=21}.
• Keep dantrolene accessible during procedures; emergency protocols and training crucial :contentReference[oaicite:22]{index=22}.

9. What to Do in Field Emergencies

• Monitor temperature, heart rate, respiratory effort.
• Initiate rapid cooling — wet towels, fans, ice packs.
• Administer IV fluids with sodium bicarbonate
• Seek immediate veterinary care — hospital access and dantrolene administration may be lifesaving.

10. Prognosis & Long‑Term Care

Untreated MH is usually fatal. Early dantrolene and supportive care reduce mortality to under 10 % :contentReference[oaicite:23]{index=23}. Affected horses should never receive triggering anesthetics again. Breeding from affected individuals should be avoided due to the autosomal dominant inheritance :contentReference[oaicite:24]{index=24}.

11. Case Reports & Evidence

• 1979 Thoroughbred: Halothane-triggered MH with fever, tachycardia, muscle rigidity; survived after cold water, dantrolene, ventilation :contentReference[oaicite:25]{index=25}.
• 1983 study: Three horses under halothane exhibited MH-like signs including elevated temperature, rigidity, breathing irregularities :contentReference[oaicite:26]{index=26}.

12. Ask A Vet Support 🩺

At Ask A Vet, we help with genetic testing coordination, pre-anesthetic planning, emergency protocols, and client education. If your horse is a susceptible breed, message us via the app for proactive risk management and crisis preparedness.

13. Quick Reference Table

14. Final Thoughts

Though rare, malignant hyperthermia poses a serious risk in susceptible horses—especially during anesthesia. Early recognition, immediate dantrolene use, and strong preventive protocols can save lives. With genetic testing and Ask A Vet support, owners can confidently navigate veterinary care in 2025 and beyond. Download the Ask A Vet app today for expert guidance and emergency readiness. ❤️