Pericardial decompression syndrome is a rare but potentially fatal complication following needle or surgical pericardiocentesis and should be recognized as paradoxical hemodynamic deterioration. The exact pathophysiology of pericardial decompression syndrome is unknown but is likely that several mechanisms involving hemodynamic, ischemic and autonomic imbalance lead to the clinical manifestation of this entity. There is no specific treatment for pericardial decompression syndrome other than supportive care, however, early interventions such as aggressive heart failure therapy, inotropic medications and sometimes mechanical circulatory support should be implement as mortality can be as high as 30%. We report a patient presenting with severe right ventricular failure and cardiogenic shock secondary to PDS.