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Vocal cord dysfunction (VCD) is an underrecognised cause of dyspnoea as it is seldom life threatening, and also difficult to diagnose. However, there have been rare accounts of VCD, as in the present case, which have led to haemodynamic instability. This patient with VCD episodically developed acute pulmonary oedema, bilateral pleural effusions and Takotsubo cardiomyopathy, treated effectively with tracheostomy. This presentation hints at the possible existence of a common pathophysiological mechanism, namely, forced inspiration against a closed airway or sympathetic overstimulation.
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