One of the most common presentations in daily clinical practice is that of a dog with mitral valve disease that is coughing. This clinical situation creates confusion and frustration in many generalist veterinarians and owners. Will cough improve if I treat heart disease? Should I always look for underlying respiratory diseases? When should I use antitussives? What are the key areas I should focus on in these cases? This presentation will focus on the analysis of this clinical situation considering the up-to-date scientific evidence and the author's experience in handling these cases.