We presented a patient with an advanced stage of endomyocardial fibrosis (EMF) who immigrated from Brazil to Framingham, Massachusetts. EMF is an extremely rare etiology of heart failure in Europe and North America, although the prevalence is high in tropical countries, including Brazil. However, as presented in our case, the incidence of EMF would increase with sporadic cases from immigration to temperate countries. Our case would help raise awareness and familiarity in diagnosing EMF, a rare and perhaps one of the most underappreciated causes of heart failure.