Background: A significant number of COVID-19 patients require mechanical ventilation and suffer from thrombotic events, including pulmonary embolism. Prevalence of ECG changes associated with right ventricular strain in COVID-19 patients on mechanical ventilatory support and with pulmonary embolism have not been well described. Material: Data on 106 consecutive patients with COVID-19 infection, treated at a single academic medical center, was collected. Standard 12-lead ECGs were reviewed for evidence of RV strain, including S wave in lead I (S1), Q wave in lead III (Q3), inverted T wave in lead III (T3), right atrial enlargement (RAE), and right bundle branch block (RBBB). Results: The study cohort included 37% females, 62+/-15 years old, with histories of diabetes in 28%, myocardial infarction in 10%, CHF in 6%, PVD in 4%, and cancer in 6%. Of the study cohort, 34 (32%) of patients required mechanical ventilation and pulmonary embolism was documented in 4 patients, 2 of whom were on mechanical ventilation, a total of 36 patients, Vented-PE group. Thirty-three patients (30.8% of the study cohort) expired. In Vented-PE patients, prevalence of Q3 (41.7% vs. 19.7% in the rest of the cohort, p=0.016) was significantly increased, which due to supine position at the time of ECG. The prevalence of S1 (33.3 vs. 29.6%, p=0.691), T3 (44 vs. 30%, p=0.127), RBBB (3 vs. 10%, p=0.188), and RAE (2.8 vs. 1.4%, p=0.621) was not significantly different between Vented-PE group and the rest of the cohort. Similarly, except for significantly more common in survivors T3 (5.6 vs. 40.4%, p=0.004), there were no significant differences in prevalence of S1 (44.4 vs. 28.1%, p=0.171), Q3 (233.3 vs 25.8%, p=0.514), RBBB (11.1 vs. 6.7%, p=0.520), or RAE (0 vs. 2.2%, p=0.521) between patients who expired and live discharges, respectively. Conclusions: In COVID-19 patients, 12 lead ECG evidence of RV strain has low prevalence and does not allow to differentiate patients who require mechanical ventilation, suffer from pulmonary embolism, or expire. RV strain should not be ruled out in these patients solely based on the normal ECG. Additional imaging studies should be considered in eligible patients with high index of suspicion for the right ventricular strain.