The epidemic of cardiovascular disease is a global phenomenon and the magnitude of its increase in incidence and prevalence in low-income countries has potentially major implications for those high-income countries that characterize the developed world. The "epidemiologic transition" provides a useful framework for understanding changes in the patterns of disease as a result of socioeconomic and demographic developments. According to the migratory flow, the burden of African immigrants in Italy is rising, and there is a need to re-assess the clinical management of anything but obsolete western cardiovascular disorders also delving into the rare tropical neglected diseases. Rheumatic fever and tropical cardiac diseases, such as endomyocardial fibrosis in Africa and Chagas disease in Latin America, require a human resource framework to direct into research and intervention programs. This review will focus upon endomyocardial fibrosis, by far the most common type of restrictive cardiomyopathy worldwide, still an unsolved puzzle from a pathophysiological point of view and in need of more attention from the international community of cardiologists. In this paper the data from the literature are implemented by our personal experience at the St. Raphael of St. Francis Hospital-Nsambya and the Ugandan Heart Institute of Kampala, the capital town of Uganda.