Introduction: It has been estimated that up to a billion people worldwide could be exposed to Zika re-emergence including North America. Zika was considered the worst outbreak of the century before COVID-19. There are only few reports of cardiac complications and the long-term risk of heart failure (HF) is unknown. This is the objective of this study. Methods: We included 19 patients who developed acute myocarditis within one week of symptomatic Zika, in a prospective observational multi-center study. Patients underwent clinical, laboratory evaluation including Zika confirmation, ECG, echocardiogram, Holter, cardiac MRI, coronary arteriography (2). Patient follow-up examinations were performed at 2, 6,12, 24, 36 and 48 months. Results: Of the 19 patients, 12 (63%) were female with a mean age of 49 ± 17 years with a median follow-up of 3 years. Nine patients (47%) developed acute HF; 8 (42%) with reduced ejection fraction (HFrEF) and one with preserved EF (HFrEF) and moderate to severe pericardial effusion. Two cases died suddenly in the first week of Zika onset, both with HFrEF. Treatment included sacubitril /valsartan, or ace-inhibitors, SGLT2 inhibitors, beta-blockers, aldosterone-blockers, cardiovascular rehabilitation, and in one case cardiac resynchronization therapy plus implanted defibrillator. There was no new HF onset after the acute phase of the disease. Myocarditis resolved in 10 (56%) patients. Persistent atrial and ventricular arrhythmia with normal EF observed in 5 (26%) of cases. Altogether, characteristic features of dilated cardiomyopathy that developed in 7 patients (36, 8%); 2 (11%) of them died. Conclusion: Almost half of the patients with Zika myocarditis developed acute HF during the first week of disease onset, none of the patients developed HF after the acute phase. A 3-year mortality rate of 10,5 % was observed.