Cardiovascular involvement is rare in tuberculosis & high index of suspicion is must in diagnosing these cases in high burden setting to have successful treatment outcome. In this case report, 26-year male, presented with constitutional symptoms for three months duration with acute deterioration with tachycardia and tachypnea with hypoxia. Radiological investigations documented conglomerated miliary tuberculosis and confirmed by sputum smear microscopy. Cardiac investigations revealed sinus tachycardia in ECG, raised cardiac enzymes, and echocardiography as ‘global left ventricular hypokinesia’ with reduced ejection fraction. Treatment initiated with steroids with anti-tuberculosis and recorded near complete radiological resolution, bacteriological cure and restored cardiac function after six months with good compliance. We recommend cardiac workup in all pulmonary tuberculosis cases with disproportionate tachycardia.