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Several months ago, our three year old domestic cat died without warning. We didn't have a necroscopy performed at the time, but were wondering what the likely cause might be.

What happened (warning: somewhat graphic):

My spouse had been playing with the cat using a wand and string style toy which had some artificially-colored feathers and a bell at the end of the string (specifically this one). While playing with the cat, a feather (we think with the bell attached) fell off onto the floor. My spouse left the room for a few minutes and then returned, not seeing the cat. After another minute or so the cat approached her then collapsed. Her back legs twitched briefly and she made some sort of noise.

I arrived on-scene about 90 seconds later. The cat was on her side on the ground and entirely limp. I didn't see any evidence of breathing and could also not hear a heartbeat. Her eyes were open and unmoving. At the time we thought she might be choking on something, so I attempted to clear her throat with my finger but couldn't feel anything obstructing it. I also tried to perform the Heimlich maneuver on her following some instructions we found online. At some point when I lowered her head some of the contents of her stomach came up, but we never observed any foreign object. Afterwards, we searched the house for the missing feather/bell, but never located it.

Vets, I would appreciate your thoughts on likely causes of death and in particular if you think there's any chance she actually choked on something. Thank you very much in advance.

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    Welcome to Pets SE, I am so sorry for your loss, it must be traumatizing :( – lila Jan 4 at 1:41
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    @lila We appreciate the thought, thank you. – ARM Jan 4 at 1:48
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Please notice that I am not a vet and this is speculation based on the information you've given in your post. I cannot possibly know for sure that this is actually the cause of death, there are other causes like a stroke or cardiac arrest that are possible as well.

The fact that the bell disappeared leads to the assumption that the cat swallowed it, which caused the sudden death. The fact that she collapsed suddenly and seemed to drop dead without a struggle leads me to the bolus death aka cafe coronary. (Either there is another name for it or Wikipedia doesn't have an article in English about it.)

A "bolus" is a mouthful of food that gets swallowed. How exactly the bolus death occurs is still subject to debate, but the consensus seems to be that such a bolus can get stuck in the larynx or esophagus, where it triggers a bundle of nerves near the throat, which cause a sudden reflex cardiac arrest. As far as I understand, bolus death can occur even when the airway is free of obstruction.

This kind of death is rather rare. The study An autopsy approach to bolus deaths found that:

Among 31,647 autopsies, 59 cases of cafe coronary syndrome were identified and evaluated: 38 male adults and 21 female adults between the ages of 26 and 89 years.

In eighty-six percent (86%) [of evaluated autopsies], boluses of meat and sausage or meat-like chunks were observed.

I'm sorry for your loss, but I hope it's at least a small consolation that your cat didn't suffer.

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