Background: Chagas disease is endemic in the southern cone of Latin America and is becoming more prevalent in the United States with more than 300,000 people infected. It is an important cause of heart block worldwide, but is thought to be rare in the United States, and therefore easily overlooked. Heart block from Chagas disease often occurs in the young, and is permanent; therefore, early diagnosis and treatment is crucial. Case report: A 37-year-old woman from Bolivia presented with decreased exercise capacity and generalized fatigue. Her electrocardiogram revealed right bundle branch block escape rhythm. Her enzyme-linked immunosorbent assay for Trypanosoma cruzi was negative, but given the high level of suspicion, an immunofluorescent antibody assay was performed, which was diagnostic. She was treated with benznidazole and permanent pacemaker placement. Conclusion: Chagas disease is becoming more prevalent in the United States and other regions of the developed world. Patients presenting from an endemic area with suggestive symptoms require investigation to detect this diagnosis because therapy restores patients to full functional capacity in the short term; in the long term, the prognosis is uncertain but cardiac surveillance for progressive ventricular dysfunction, thrombosis, and tachyarrhythmia is indicated. Treatment with anti-trypanosomal agents should be offered to patients with chronic Chagas disease and a permanent pacemaker should be considered in symptomatic patients with bradycardia.