Background: Asthma is a common chronic respiratory disease affecting (7-10%) of the population in different countries. It is characterized by variable symptoms of wheeze, shortness of breath, chest tightness and cough. Asthma is usually associated with airway hyper-responsiveness to direct or indirect stimuli. Patient with acute asthma will manifest electrocardiograghic changes ranging from sinus tachycardia, P, ST and T wave changes etc, these abnormalities persisted for up to 10 days, may reflect positional changes of the heart, were reverted to normal after therapy. Aims: To study the various ECG abnormalities in acute asthma and to demonstrate the reversibility of these abnormalities after treatment. Material and Methods: This study was conducted on (110) patients all were adults, their age ranged from 20 years to more than 50 years who attended to the emergency department in Kirkuk General Hospital over a period of one year from April 2017 to April 2018 with aconfirmed diagnosis of acute severe asthma were studied. Ten patients were excluded from study because their ECG changes were related to cardiac and thyroid disorder. Patients were included in the study only if an ECG had been performed on admission and within 24 hour of their stay in hospital. A standard 12 Lead ECG was performed on admission for each patient and it repeated until it had returned to normal. In each patient, on admission, plasma urea, full blood count, thyroid functions test (in selected cases) cardiac enzymes (in those with chest pain) were performed. The diagnosis of acute asthma is made by taking a thorough history and physical exam, and patients without a previous diagnosis of asthma, a spirometry performed to confirm airway obstruction and reversibility. Result: The commonest ECG changes were sinus tachycardia which was found in (50%) of patients with a heart rate ranging between 120-130 beats/ min, while the lowest rate of ECG changes was right bundle branch block were observed in (2%) of patients. The male patients were affected more than female and the highest incidence observed was among age group 41-50 years. The ST segment depression, T wave inversion & sinus tachycardia are the main ECG changes in (30%) of life threatening type of acute asthma. While P pulmonale & ST segment depression were observed in only (4%) of patients with near fatal asthma. Conclusion: Patients with acute asthma can manifest various ECG changes and these changes returned to normal after medical therapy, usually within 10 days.