It is estimated that over 300,000 people with Chagas disease are living in the USA, with more than 30,000 cases of Chagas cardiomyopathy expected per year. The epidemiology of Chagas disease in Central and South America differs from that of the USA, where particular attention must focus on blood bank screening, organ donation and vertical transmission. It is essential that healthcare practitioners have heightened awareness of Chagas disease in the differential diagnosis of certain patients and are aware of recommendations for the management of these patients in the USA. Ongoing attention must focus on trials that determine whether all patients will benefit from treatment as well as studies of new agents for therapy.