Background: There are high impact of COVID-19 disease on cardiovascular system in either acute or recovery phase. The cardiac complications of COVID-19 are easily reflected by electrocardiography and echocardiography.

Aim: To predict significant cardiovascular affection throughout course of COVID-19 infection using electrocardiography and echocardiography. .

Methods: This retrospective cohort study was conducted at Cardiology Department, Faculty of Medicine and isolation department at Zagazig University Hospitals during the period of 2021 to 2022 on 100 cases with suspected or confirmed COVID-19. All patients were subjected to electrocardiographic and Echocardiographic assessment.

Results: QTc and number of patients with abnormal ECG were significantly higher in severe group compared to non-severe group. PR interval was significantly higher in severe group compared to non-severe group. LV mass, EF, E, and E/A ratio were significantly lower in severe group compared to non-severe group. LVEDD, A, number of patients with diastolic dysfunction and number of patients with pericardial effusion were significantly higher in severe group compared to non-severe group (P<0.05). Valvular lesion was significantly different between both groups.

Conclusion: Patients with severe COVID-19 disease exhibit significantly worse cardiac pathology across structural, systolic, and diastolic function compared to non-severe disease. Severe patients showed markers of myocardial injury, elevated cardiac biomarkers, ECG changes, impaired left ventricular function, and higher rates of arrhythmias, valvular lesions, pericardial effusion, and diastolic dysfunction.