Delayed post-operative cardiac tamponade manifesting as cardiogenic shock

We describe the case of a 32-year-old woman with a history of cardiac surgery two weeks previously who presented with an upper gastrointestinal bleed. She also had symptoms of syncope and abdominal pain, as well as elevated liver enzymes. She had cool, clammy extremities, bilateral lower extremity edema, and oliguria. An echocardiogram was obtained, which revealed a large posterior pericardial effusion with evidence of tamponade physiology, and an emergent pericardiocentesis was performed with insertion of a drainage catheter, which drained bloody fluid, with subsequent hemodynamic improvement. <Learning objective: Cardiac tamponade symptomatology may vary tremendously from patient to patient, and therefore requires a high clinical suspicion in those presenting with evidence of cardiogenic shock. Understanding signs, symptoms, and physiology of cardiac tamponade is essential for diagnosis of delayed post-operative cardiac tamponade, occurring >7 days after open-heart surgery, a challenging diagnosis given its vague symptoms and signs not classically associated with the condition.>.