Background: Dengue fever has been increasingly recognized for its potential cardiac complications beyond the traditional hematological manifestations. This study aimed to evaluate the spectrum of echocardiographic changes in patients with dengue fever and assess their clinical significance. Material and Methods: We conducted a prospective observational study on 100 confirmed dengue patients admitted to our tertiary care hospital. All patients underwent comprehensive echocardiographic evaluation on admission and follow-up assessments as clinically indicated. Correlation with clinical severity, biomarkers, and outcomes was analyzed. Results: Echocardiographic abnormalities were detected in 28% of patients (95% CI: 19.5-37.9%). The most common findings were left ventricular systolic dysfunction (10%), diastolic dysfunction (8%), pericardial effusion (7%), and regional wall motion abnormalities (3%). Patients with severe dengue had significantly higher incidence of echocardiographic abnormalities compared to non-severe cases (45.8% vs. 21.1%, p=0.009). Left ventricular ejection fraction was significantly lower in the severe dengue group (54.2±8.7% vs. 61.3±5.2%, p<0.001). Most echocardiographic abnormalities resolved by follow-up at 4 weeks, although 3% of patients had persistent changes. Conclusion: Echocardiographic abnormalities are common in dengue fever, with higher prevalence in severe cases. Routine echocardiography may be beneficial for early detection of cardiac involvement, especially in severe dengue, to guide appropriate management strategies and improve outcomes.