Neuroendocrine tumors (NETs) may present in various ways, including as a result of carcinoid syndrome (CS). Typical manifestations of CS include chronic flushing and/or diarrhea, though a well-established complication is carcinoid heart disease (CHD) which has a profound impact on morbidity and mortality. We present a 21-year-old male hospitalized for acute onset of decompensated right-sided heart failure (RHF) due to underlying CS. Our case emphasizes the importance of considering CS in the differential diagnosis for patients presenting with right-sided heart failure, particularly in the absence of common risk factors such as advanced age and ischemic heart disease.