Cardiovascular complications caused by chronic obstructive pulmonary disease (COPD) will change the normal function and the shape of the heart's anatomy. The purpose of this study to determine whether there was a relationship between the degree of severity of COPD and electrocardiogram (ECG) changes. Methods: A cross-sectional analysis conduct on 80 subjects who fulfilled inclusion criteria at the outpatient cardiology clinic H. Adam Malik Hospital Medan. The subject was divided equally based

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... the severity of COPD and ECG examination was performed. Statistical analysis processed using multivariate with p>0,05 as statistical significance The correlation is presented as Pearson r values and new values are obtained by the ROC curve. Results: The mean age was 57±13 years with males have a majority proportion (85%). P Pulmonale and RBBB were common in severe COPD (GOLD 3 p = 0.001, GOLD 4 p <0.001). P wave axis and the amplitude of the P wave was found to be significantly different (p <0.001) with a strong and moderate correlation (r = 0.706 and r = 0.577). P-axis values of more than 56.3 degrees and P-wave amplitudes of more than 0.15 mV had a sensitivity of 80-85% and specificity of 80% to differentiate more severe COPD. Conclusion: ECG assessment can be used to differentiate severe COPD with a fairly good correlation. ECG assessment in COPD patients can be used as the initial modality for assessing severe COPD (GOLD 3 and GOLD 4) at H. Adam Malik Hospital Medan.