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Gastropericardial fistula presenting with cardiac arrest: a case report. Introduction: Gastropericardial fistulas are rare conditions, with less than 100 reported cases. The diagnosis is associated with significant morbidity, prolonged hospitalization and often has a fatal outcome. Case presentation: We describe a unique case of cardiac arrest caused by pneumopericardium and cardiac tamponade as the acute presentation of a gastropericardial fistula, in a patient admitted with an infection of unknown origin. Rapid return of spontaneous circulation occurred, and a computed tomography scan revealed the diagnosis. A benign penetrating ulcer was found on gastroscopy, and surgical management with laparotomy and gastrorrhaphy was performed. The patient had no risk factors for gastric ulceration. However, he had significant comorbidity, which makes survival through a complicated postoperative course to full recovery remarkable. Discussion: This case shows that pneumopericardium due to a penetrating benign gastric ulcer can cause cardiac tamponade, and illustrates the value of a multidisciplinary approach to management.