When you are trying to decide whether a hypotensive patient could have a cardiac component it is often fairly easy to rule it in or out on the basis of signalment and history and whether it has a murmur or a gallop. Unless you are unlucky, dogs will often have a history that will help you: coughing, exercise intolerance, dyspnoea or orthopnoea, or even a previous diagnosis of heart disease. Cats in heart failure may have no premonitory signs at all. In my experience, the majority of emergency patients that have heart disease will have a murmur or a gallop (an extra heart sound). Provided that you can find it that is! In dogs it is usually a murmur. In cats it can be either. The only ones that I can think of that don’t are really low output DCM and the ones where I have missed it! These radiographs are from this cat. Who had heart disease. And who is dead.