Background: Acute pancreatitis is a primarily noninfectious inflammatory disease of the pancreatic gland. The cardiovascular system involvement has been described before, in the form of electrocardiogram (ECG) changes and echocardiographic findings (diastolic, systolic or combined dysfunction, wall motion abnormalities and pericardial effusion).  The current study aimed to detect echocardiographic and ECG changes in acute pancreatitis and investigate the significance of these changes on prognosis. Patients and methods: A prospective observational study was conducted on 54 patients with acute pancreatitis (according to Atlanta score) admitted to Internal Medicine Department, Assiut University, Egypt. All patients were subjected full clinical and laboratory evaluation in addition to assessment of ECG changes and echocardiographic findings. Results: The mean age of patients was 45.72 (SD 12.3) years and ranged from 19 to 70 years, with 51.9% of them were females. The probable cause in the majority of the study patients was gall stone (42.6%). The present study showed several possible ECG changes; T-wave Changes and Prolonged Q-R Interval had significant impact on the rate of complications. Also, left ventricular (LV) diastolic dysfunction and pericardial effusion at discharge had significant impact on the rate of complications. At discharge echo changes had no impact on the rate of complications. Poor R-wave progression (PRWP), ST segment elevation and T-wave changes had significant association with mortality. Female sex, comorbidity, Ranson Severity Score, white blood cells (WBCs), blood urea nitrogen (BUN) follow up, calcium Level, albumin, Basal deficit, ST segment elevation, regional wall motion abnormality (RWMA) baseline, left ventricular diastolic dysfunction (LVDD) on discharge and right ventricular systolic dysfunction (RVSD) on discharge could significantly predict mortality among cases. Conclusion: Echocardiographic and ECG changes in patients with acute pancreatitis could predict the outcome of those patients. Future studies on larger sample sizes are warranted to confirm such findings.