Abstract
A 66-year-old woman tripped and fell onto outstretched hands. She did not hit her chest. She developed chest pain and presented to the emergency department in shock. Transthoracic echocardiography demonstrated a large pericardial effusion with cardiac tamponade. Despite recurrent pericardiocentesis, the fluid did not decrease on echocardiography, and she continued to be in profound shock. Emergent surgical exploration identified rupture of the right atrium at its insertion into the superior vena cava. This case demonstrates atrial rupture despite no obvious direct chest impact and emphasizes the need for emergent surgical exploration in patients with hemopericardium and persistent tamponade despite pericardiocentesis.