Tricuspid regurgitation can be due to different causes and mechanisms. Among these, cardiac involvement in carcinoid disease is a rare cause of tricuspid valve disease with a peculiar echocardiographic aspect. We report the case of a 59-year-old woman, with no past medical history, who was recently found to have a heart murmur and signs of right heart failure. The echocardiogram showed a remodeling of valvular and subvalvular apparatus, resulting in massive regurgitation. This finding prompted further diagnostic investigations, leading to the diagnosis of carcinoid syndrome with cardiac involvement. This case report therefore provides an opportunity to discuss the pathophysiological aspects and the diagnostic process of carcinoid heart disease, focusing particularly on the echocardiographic features and therapeutic management.