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Dyspnea and Cough

Key Points

• Episodic, short duration dyspneic events are not typical of congestive heart failure. Dyspneic periods secondary to congestive
heart failure tend to be progressive in nature.
• Open mouth breathing/panting in cats can occur secondary to respiratory difficulty or anxiety. Anxious, preoccupied mentation
is equally or more closely linked to respiratory difficulty.
• The duration or character of dyspnea does not allow differentiation of the underlying cause (primary respiratory disease vs
pleural effusion vs pulmonary edema).
• Coughing is rarely associated with underlying heart disease in the cat. This clinical sign is most often associated with
underlying airway disease, such as feline asthma.

Dyspnea, or abnormal breathing (used clinically to polyps and malignant tumors, and other noncardio-
describe difficulty breathing), is one of the most common genic disorders.
signs recognized by owners with cats experiencing con- Lower airway disease, in particular feline asthma, is
gestive heart failure due to pulmonary edema or pleural characterized by bronchoconstriction and inflammatory
effusion. However, although dyspnea in cats commonly exudate in the airways. These cats often present with a
occurs secondary to heart disease, it is also frequently history of coughing and an obstructive respiratory
associated with lower airway disease or pleural space pattern, with an increase expiratory effort (Mandell
disease. Some owners will first recognize dyspnea as an 2004). Other common clinical signs associated with
increased abdominal effort associated with respiration. congestive heart failure in cats include hiding, anorexia,
One study described 14 cats with tricuspid valve dyspla- restlessness, or tachypnea (an increased respiratory
sia, and the most common abnormality recognized rate); the cat may even prefer to sit or lie in a sternal
by owners was dyspnea visible as discordant/opposite position (orthopnea). See Box 4.1 for a differential list
chest and abdominal wall movements (5/14 cats, 36%); of the common diseases causing feline dyspnea. See
this finding was compared to the chief complaints of 36 Figure 4.1 for a therapeutic plan to address the dyspneic
dogs with the same cardiac disease and none of the 36 feline patient.
dogs’ owners described dyspnea this way (Chetboul Coughing is defined as a sudden expiratory effort,
et al. 2004). initially against a closed glottis, resulting in expulsion
Upper airway disease leads to stridor, a harsh, high- of air from the lungs. The cough reflex results from
pitched respiratory sound usually heard on inspiration. irritation (mechanical or chemical) at the level of the
These cats may also have a history of snoring, intermit- pharynx, larynx, tracheobronchial tree, and some of
tent open mouth breathing or nasal discharge. Possible the smaller airways. It is a sign of any of a handful of
nasolaryngeal and laryngeal disorders include benign possible underlying disorders. The cough may be

Feline Cardiology, First Edition. Etienne Côté, Kristin A. MacDonald, Kathryn M. Meurs, Meg M. Sleeper.
© 2011 John Wiley & Sons, Inc. Published 2011 by John Wiley & Sons, Inc.

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