Tumour Necrosis Factor-alpha antagonists constitute an important part of the therapeutic armamentarium available for managing autoimmune diseases such as rheumatoid arthritis and psoriatic arthropathy. Here, we present the case of a 68-year old male with severe rheumatoid arthritis who developed chest pains and severe left ventricular systolic dysfunction following etanercept therapy. Etanercept was discontinued while he was commenced on standard heart failure treatment. This, consequently, led to complete resolution of his symptoms and recovery of left ventricular function to near normal. Previous literature involving similar case reports is reviewed and implications for clinical practice are discussed with emphasis on the need for a screening protocol when commencing such therapy.