Abstract: COVID-19 associated Multisystem inflammatory syndrome in adults (MIS-A) can present with varied cardiac manifestations like ST segment changes, wall motion abnormalities, arrythmias and valvular abnormalities. Although the CDC has released criteria for diagnosis in July 2020, there is still a lack of clarity due to the varied presentation of cases and overlap of symptoms with other common disease conditions. A delay in diagnosis due to time taken to rule out other conditions can delay appropriate treatment. We present a case of an adult male who presented with fever, chest discomfort and abdominal symptoms with a history of previous COVID-19 infection. His vitals were stable without any signs of cardiac failure. We tested for COVID-19 antigen, antibody, and inflammatory markers. ECG and CT-chest and abdomen showed ST-T changes and a significant pericardial effusion. Though there were no cardiac symptoms, he was monitored with serial Troponin T and transthoracic ECHO cardiography which helped us to pick up deterioration of cardiac function. An immediate coronary angiogram was done which was normal. He was treated with corticosteroids, diuretics and colchicine and with daily monitoring his cardiac function improved. The pathophysiology of MIS-A is currently not well understood and a pericardial effusion without any significant cardiac symptoms as a presentation of MIS-A has not been reported previously. A multi-disciplinary approach and a high index of suspicion was required along with vigilant monitoring in an intensive care setup to recognise and treat this patient who had a good recovery with supportive care.