Cardiovascular disorders are a vital manifestation of systemic diseases and lead to substantial mortality and morbidity. Echocardiography has emerged as a useful noninvasive modality for the screening and evaluating cardiac involvement in these cases. The technological advances in echocardiographic techniques and the concomitant advances in the recognition of subclinical diseases have led to a greater appreciation of the nature and prevalence of cardiac involvement in this group of patients. The present chapter reviews cardiac involvement in patients with systemic lupus erythematosus, antiphospholipid antibody syndrome, Takayasu arteritis, and ankylosing spondylitis and introduces the role of echocardiographic imaging modalities in their evaluation.