Background: Previous studies have demonstrated that COVID 19 is associated with significant right ventricular dila-tation (RV) and systolic dysfunction. Aim of Study: To evaluate the prevalence of right ventricu-lar dilatation and enlargement and impaired pumping function among patients with acute Covid-19 infection and its relation-ship with in-hospital outcome. Patients and Methods: In this study, 90 adult patients with acute severe COVID-19 infection who were admitted consecu-tively to ELMOKATTAM Health Insurance Hospital between August 2020 and February 2021 were included. All cases had full history taking, clinical, laboratory and echocardiography examinations, including measurement of right ventricular di-mension and systolic function using tricuspid annular plane systolic excursion (TAPSE). Results: RV abnormalities were found in 27 patients out of 90 (30%) with RV dilatation as the most common (25 pa-tients, 27.8%), followed by RV systolic dysfunction (10 pa-tients, 11.1%). RV abnormalities were associated with more severe lung disease based on CT chest severity score. Also, RV abnormalities was associated with less oxygen saturation, more use of mechanical ventilation and vasopressors. Cases with RV abnormalities showed higher levels of D-dimer, fer-ritin, troponin, CK-MB, serum creatinine and total leucocytic count. By employing multi-variate logistic regression analysis, RV dilatation revealed independent association with mortality during hospitalization (OR: 6.13, CI: 1.368 - 27.469, p: 0.018) along with total leucocytic count and oxygen saturation. Conclusion: RV enlargement & systolic dysfunction was observed within 30% and 11% of cases hospitalized with se-vere COVID-19 infection, respectively. The RV enlargement demonstrated an independent association with mortality dur-ing hospitalization.