We describe a 55-year-old man who presented with acute left ventricular dysfunction and congestive heart failure caused by rheumatic carditis. The diagnosis of rheumatic carditis was established by percutaneous endomyocardial biopsy. Since many physicians may not be familiar with some of the clinical and histopathologic features of rheumatic carditis, we submit this report as a reminder that the disease has not disappeared, should be considered in the differential diagnosis of acute heart failure, and can be diagnosed by endomyocardial biopsy.