Background: Cardiomyopathy is the leading cause of morbidity and mortality in patients with acromegaly. Pharmacological and surgical treatment of the disease has been associated with morphological and functional benefits for the heart, but other studies have shown that the condition and its effects may be irreversible. This study aims to uncover the most frequent echocardiographic changes in patients with cardiomyopathy due to acromegaly. Methods: An observational, descriptive, cross-sectional study was performed. Patients were referred from the Endocrinology department to the Cardiology department. This study was conducted from November 2020 to November 2022. Patients with the following criteria were included: over 18 years of age, of both genders, and with a complete clinical record and complete laboratory studies. Results: A total of 89 men (38%) and 148 women (62%) were included, with a mean age of 48 ± 12 years in the men and 49 ± 13 years in the women (p = 0.223). The most frequent cardiac findings were concentric hypertrophy (CHT) in 116 patients (49%), concentric remodeling (CR) in 52 patients (22%), and eccentric hypertrophy (EH) in 18 patients (8%). The left ventricular ejection fraction (LVEF) was preserved in the entire population. Left atrial enlargement (LAE) was observed in 88 patients (37%), diastolic dysfunction in 61 patients (26%), right ventricular dilatation in 47 patients (20%), right atrial enlargement in 120 patients (51), and pulmonary hypertension in 28 patients (12%). Valvular insufficiencies (VIs) were observed: tricuspid VIs in 73%, mitral VIs in 49%, and aortic VIs in 24% of the population. Conclusions: The frequency of changes in the four chambers is elevated in cardiomyopathy due to acromegaly.