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A 57-year-old man with end-stage heart failure presented with incessant ventricular tachycardia in the setting of cardiogenic shock, requiring support with a percutaneous left ventricular assist device. He underwent ablation of the ventricular tachycardia. Hours later the console alarm was evident, and the patient experienced worsening shock and elevated central venous pressure, leading to a diagnosis of cardiac tamponade. (Level of Difficulty: Advanced.)