An 11-year old, spayed female Chinese Crested presented to the Cornell University Hospital for Animals (CUHA) Emergency Service for respiratory distress. Approximately 1 year ago, she was diagnosed with grade V/VI left holosystolic apical murmur. In the last couple months, she began having occasional bouts of coughing and increasing lethargy and exercise intolerance. In the evening of presentation after eating her evening meal, she had a coughing fit that lasted 15-20 minutes and became very dyspneic. For immediate stabilization, the patient was placed in an oxygen cage and was given butorphanol, albuterol, and 2 doses of furosemide. After initial stabilization, orthogonal radiographs were performed and revealed left-sided cardiomegaly and pulmonary edema. Based on the patient's signalment, history, clinical signs, physical exam, and radiographs, the top differential diagnosis was congestive heart failure secondary to chronic valve disease. She was transferred to the Cardiology Service the next morning for further evaluation. Echocardiogram was performed and she was diagnosed with advanced chronic valve (mitral and tricuspid) disease, ruptured chordae teninae, and moderate pulmonary hypertension. The patient was discharged with furosemide, benazepril, and pimobendan.