Pericardial effusion with tamponade and pulmonary embolism as concomitant diseases are found almost exclusively in patients with cancer and pose a diagnostic and therapeutic dilemma (1, 2). We present a case of a 73-years-old female patient with concomitant cardiac tamponade and pulmonary embolism. At initial presentation patient complained about progressive dyspnea and showed clinical signs of imminent cardiac tamponade with reduced blood pressure and tachycardia and the “electrical alternans” pattern in the electrocardiogram (Figure 1). After initial pericardiocentesis, hemodynamic stability was obtained. Due to concomitant pulmonary embolism, therapeutic dose of heparin was initiated, without any hemorrhagic complication during hospitalization. Pericardial fluid analysis showed metastatic cells and ovarian cancer as a primary site was found on the CT scan. After discharge, treatment with direct oral anticoagulant (apixaban) was continued and chemotherapy with capacitabine was started. The patient is doing well on routine three-month follow up.