Large pericardial effusion with impending cardiovascular collapse is a differential diagnosis to be considered in a patient presenting with highly unstable vitals with severe shortness of breath and tachypnea. Point of care ultrasonography helps to catch the diagnosis and intervene immediately to save a life. Pericardiocentesis is an essential skill to be learnt by doctors working in the emergency department. A 25-year female with no known comorbidities was brought to the ED with severe breathlessness. Patient was connected to a cardiac monitor. She was conscious and oriented . The vitals were recorded as heart rate 116 bpm, BP 170/100 , SpO2 97% on room air and this had started  one month back, insidiously progressed to grade IV . The attendants informed that she is not able to lie supine from one day because of shortness of breath. We enquired about fever,cough and chest pain  which were absent. Patient had bilateral pedal edema from 15 days which had progressed to generalized edema over the last 2 days. There was a history of  anorexia and significant weight loss over the last one month . The patient had no complaints of oliguria, jaundice, rash , joint pains or oral ulcers. Physical examination revealed distended neck veins , pallor , pedal edema extending upto thigh level, normal heart sounds and crepitations in bilateral infra-axillary regions. Our working differentials were looking for an underlying cardiac, respiratory or malignant cause for acute presentation of this patient.