The big squeeze: balancing the hemodynamics of cardiac tamponade and superior vena cava syndrome

In this clinical vignette, we describe an unusual aetiology of shock that was precipitated by the drainage of malignant pericardial effusion. Therapeutic intervention of the patient’s cardiac tamponade led to decreased venous pressures, increased external lung mass compression, worsening superior vena cava syndrome, and ultimately haemodynamic compromise leading to his expiration.