We present the case of a 55-year-old woman with a relevant medical history of migraines who was referred for evaluation from the emergency room. Upon our arrival, the patient was in poor general condition, hypotensive (70/40 mmHg), and in sinus tachycardia at 110 bpm. The patient reported precordial pain that had started the previous night, without any infectious symptoms in the preceding weeks. An emergent bedside echocardiogram was performed, revealing severe circumferential pericardial effusion with echocardiographic signs of tamponade. Intensive fluid therapy was initiated in the critical care unit, along with a norepinephrine infusion, and the patient was emergently transferred to the operating room for pericardiocentesis [1]. During the procedure, 250 cc of clear fluid was obtained, which had negative cytology for malignant cells and exudative characteristics according to Light’s criteria. The patient was later admitted in stable