OBJECTIVE: To determine the prevalence and characteristics of myocardial dysfunction and other cardiac manifestations in acutely ill hospital patients infected with human immunodeficiency virus (HIV) in Zimbabwe. DESIGN: A prospective echocardiographic survey of acutely ill HIV seropositive patients. SETTING: General medical ward, Harare Central Hospital, Zimbabwe. PATIENTS: One hundred and fifty seven HIV seropositive patients admitted with various acute medical conditions over a 12 month period, January to December 1994. MAIN OUTCOME MEASURES: Detection of myocardial dysfunction and other cardiac abnormalities by cross sectional echocardiography. RESULTS: Eighty (51%) men and 77 women were studied (mean (SD) age 34.4 (8.5), range 15-60 years for males and 31.6 (9.0), range 16-65 years for females). They were all heterosexual. None was haemophiliac or an intravenous drug user. Echocardiographic abnormalities were found in 79 (50%) patients: 14/151 (9%) had dilated cardiomyopathy, 33/151 (22%) left ventricular dysfunction, 9/151 isolated right ventricular dilatation, and 30/157 (19%) pericardial disease (28 with effusions, three having tamponade). There were two cases of constrictive pericarditis and one of ascending aortic aneurysm. CONCLUSIONS: There is a high prevalence of echocardiographically detected myocardial and pericardial disease in this group of acutely ill HIV infected patients. Left ventricular dysfunction without dilatation was common, but its significance was not ascertained.