 In a survey of over 220,000 horse starts in UK Flat and National Hunt (jump) racing, 185 cases of epistaxis were identified (0.83 per 1000 starts).Similar frequencies have been reported in Japan (1.5 per 1000 starts) and South Africa (1.65 per 1000 starts), whereas a higher frequency has been reported in Korean (8.4 per 1000 starts).Unless a horse has severe EIPH, with blood present at the nostrils (known as epistaxis), the main sign is usually poor athletic performance; other signs are generally subtle and not easy to detect.