Owing to the high prevalence of tuberculosis (TB) and human immunodeficiency virus/AIDS, tuberculous heart disease remains an important problem in TB endemic areas. In this review, we reiterate salient aspects of the traditional understanding and approach to its management, and provide important updates on the pathophysiology, diagnosis, and treatment garnered over the past decade of focused clinical and basic science research. We emphasize that, if implemented widely, these improved evidence-based approaches to the disease can build on the early progress made in treating tuberculous heart disease and help further the goal of significantly reducing its historically high morbidity and mortality.