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Background: Heart disease in the developing world is mainly due to nonischemic causes-hypertensive heart disease, valvular and myocardial damage from rheumatic fever, and heart muscle diseases caused by certain infectious agents, for example, cardiomyopathy from HIV infection. Peripartum cardiomyopathy is also a well-recognized cause of heart disease in developing countries. However, there is evidence of epidemiological transition toward the increasing prevalence of atherosclerotic cardiovascular disease in Sub-Saharan Africa largely because of the increasing prevalence of traditional risk factors, such as hypertension, diabetes mellitus, dyslipidemia, obesity, and cigarette smoking. Aim: The aim of this study was to determine the pattern of heart diseases among patients undergoing transthoracic echocardiographic evaluation between February 2012 and February 2017 at the Cardiology Unit of the Department of Medicine, Federal Teaching Hospital, Gombe, Gombe State. Materials and Methods: Echocardiographic data of patients from February 2012 to February 2017 were retrieved. A total of 2265 patient records were analyzed. All patients had standard resting transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics were used in assessing the distribution of different heart diseases. Results: The age range of the 2265 patients was 14–89 years, with a mean age of 47.3 ± 20.1 years and a female preponderance (58%). The most common heart disease among these patients was hypertensive heart disease (41.8%) followed by cardiomyopathies (15.4%). Ischemic heart disease remains rare (0.7%) probably due to the investigative modality used in this study (resting transthoracic echocardiography). Conclusion: Hypertensive heart disease remains the most common heart disease among men and women in Gombe and its environs. Cardiomyopathies, although rare in certain regions of Nigeria, are quite common in Northeast Nigeria.