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Background: Acute prosthetic valve dysfunction is a serious complication following valve replacement surgeries. Extrinsic prosthetic valve obstructions usually limit valve function, thus affecting cardiac output. Materials and methods: We report a case of double valve replacements with mono leaflet tilting disc valves and tricuspid repair. Patient had normal prosthetic valve function in immediate post-operative period. She developed episodes of pulseless electrical activity with low cardiac output on the first post-operative day. Patient was re-explored with suspicion of valve dysfunction and pericardial effusion. Transesophageal echocardiogram showed intermittent extrinsic obstruction of mitral prosthesis. Results: We observe that acute prosthetic dysfunction can present with unexplained pulse less electrical activity and can be confirmed with transesophageal echocardiography. Conclusion: Electro mechanical dissociation and low cardiac output following prosthetic valve replacement may be due to acute prosthetic dysfunction. A high index of suspicion and early intervention can be vital in such patients.