Background: Focused cardiac ultrasound (FOCUS) can augment the cardiac exam in primary care but is operator-dependent. We evaluated the diagnostic performance of artificial intelligence-assisted FOCUS (AI-FOCUS) performed by family physicians against cardiologist-performed echocardiography. Methods: This research is a prospective cross-sectional study in primary care; family physicians performed conventional FOCUS and AI-FOCUS, with cardiologist-performed echocardiography within 24 h as the reference standard. The primary outcomes were accuracy, sensitivity/specificity, and agreement (κ). Results: AI-FOCUS achieved 94.33% accuracy (95% CI 93.15–95.35), 89.91% sensitivity, and 96.49% specificity, with excellent agreement compared to cardiologists (κ = 0.88). Among the confirmed abnormalities (32.9% of participants), valvular disease was most frequent (42%), followed by reduced LVEF < 50% (28%) and pericardial effusion (12%). In multivariable analysis, AI-assisted LVEF < 50% (OR = 6.05, p < 0.0001) and valvular abnormalities (OR = 4.05, p < 0.0001) were strong predictors of cardiac pathology. Conclusions: AI-FOCUS performed by trained family physicians showed high diagnostic accuracy and excellent agreement with blinded cardiologist-performed echocardiography for detecting LVEF < 50%, screening-level valvular abnormalities, and pericardial effusion, supporting its use for early detection and triage in primary care. Its ease of use and reproducibility suggest value in settings with limited access to cardiology.