BACKGROUND: In multisystem inflammatory syndrome in children (MIS-C) with coronavirus disease 2019, there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes. We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes. AIM: To determine association between cardiovascular abnormalities and clinical and laboratory parameters. To study the time-line for resolution of various abnormalities. METHODS: In this prospective study done in a tertiary care hospital, 270 were recruited from June 2020 to January 2022. Baseline demographic data and clinical presentation were recorded. Laboratory parameters and echocardiography were done at admission. Follow-up was done at 2 weeks, 3 months, 6 months and 1 year after diagnosis. Descriptive statistics were used for parametric and non-parametric data. Risk factors were identified by multivariate regression analysis. RESULTS: The 211 (78.2%) had cardiac involvement and 102 needed intensive care unit (ICU) admission. Cardiovascular abnormalities observed were shock 123 (45.6%), coronary dilatation 28 (10.4%), coronary aneurysm 77 (28.5%), left ventricular (LV) dysfunction 78 (29.3%), mitral regurgitation (MR) 77 (28.5%) and pericardial effusion 98 (36.3%). Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7% and 0.9% respectively. Multivariate regression analysis revealed breathlessness [odds ratio (OR) = 3.91, 95%CI: 1.25-12.21, CONCLUSION: Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management. Although shock resolved quickly, resolution of ventricular function and coronary abnormalities were slower, and hence warrants a structured long-term follow-up protocol.