Distant metastasis from head and neck cancers is a rare occurrence, especially in the case of HPV positive primaries, which are statistically less aggressive than HPV negative tumors. Our patient presented with a p16 positive oropharyngeal cancer, a surrogate marker for HPV. He underwent a laser pharyngectomy and radical neck dissection with adjuvant post-op radiation therapy. Approximately two years later our patient presented to hospital with an atypical presentation of cardiac tamponade. Pathology from tissue obtained at the time of a pericardial window was consistent with malignant squamous cell carcinoma of the pericardium. No local disease recurrence was found. Despite his low risk profile and the effective loco-regional control of his disease, he eventually succumbed to complications from distant metastasis. This is the first report of an HPV positive oropharyngeal primary with distant cardiac metastasis, to our knowledge. Considering the rarity of this outcome and the atypical presentation seen in our patient, we hope to use this report to raise awareness on the possibility of cardiac metastasis in head and neck cancer survivors presenting with non-specific or new cardiac signs/symptoms with unknown etiology.