Chagas' cardiomyopathy is the most frequent and severe clinical manifestation of chronic Chagas' disease, and is associated with poor prognosis and high mortality rate. Cardiac arrhythmias may cause palpitations, lightheadedness, dizziness, and syncope. Autonomic dysfunction results in marked heart rate abnormalities, especially bradycardia. Sudden death is an occasional complication that may be precipitated by exercise and can be explained by ventricular tachycardia or fibrillation or complete heart block. Mural thrombi form in cardiac chambers and may result in systemic emboli. Stroke is the most important complication of embolism in Chagas' cardiomyopathy. The most commonly used diagnostic test is based on complement fixation, immunofluorescence, or enzyme-linked immunofluorescence assays. Chagas' disease can be diagnosed with greater sensitivity by the detection of Trypanosoma cruzi-specific sequence of DNA. Chagas' disease patients with acute ischemic stroke may also benefit from recombinant tissue plasminogen activator (rtPA).