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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 (subac