Coronary perforation is an uncommon complication of percutaneous coronary intervention (PCI), that, in extreme cases, might result in cardiac tamponade. Here, we describe a case of coronary artery perforation in a 55-year-old female, presented with recent inferior wall myocardial infraction (IWMI). Coronary angiogram represented right coronary artery (RCA) lesion which was planned to manage with PCI. During PCI, coronary perforation emerged in RCA, leading to cardiac tamponade. Hence an immediate pericardiocentesis was performed and coronary perforation was tackled successfully using a covered stent. Keywords: Coronary perforation, percutaneous coronary intervention (PCI), cardiac tamponade, cath lab nightmare.