Novak B. was discharged home following his myocardial infarction. He felt well for 4 days. He then developed an episode of dull retrosternal chest pain lasting for 2 hours. He felt this was somewhat different than the chest pain he had presented to hospital with during his MI. He felt unwell and was pale and diaphoretic on arrival at the ER. In the ER, his BP dropped to 85/55 mmHg, RR 32, HR 135 bpm, his JVP was elevated at 10 cm above the sternal angle. His lungs were clear to auscultation. Precordial examination demonstrated soft heart sounds. An EKG demonstrated sinus tachycardia with generalized low voltages and no new ST segment abnormalities. An echocardiogram was performed immediately and demonstrated a large pericardial effusion.