Background: Beta thalassemia major (BTM), an inherited hemoglobinopathy, is characterized by absent or severely reduced β-globin chain synthesis, resulting in transfusion-dependent anemia that begins early in life. Cardiac complications, primarily iron-overload cardiomyopathy and congestive heart failure, remain the most common cause of mortality in these patients despite several decades of advances in supportive care. Objective: To investigate the cardiac function in Iraqi children with BTM using ECG and Echocardiography, to determine whether abnormal findings of these tests are related to inadequate chelation therapy (assessed by urine drug levels) and body iron overload (estimated by serum ferritin), and to assess the correlation between CXR parameters versus echocardiographic measurements. Methods: A cross-sectional study of 49 patients with beta-thalassemia major (BTM) disorder followed up at the outpatient clinic of AL-Zahraa Teaching Hospital, Al-Najaf, Iraq, from June to November 2025, comprising 29 males and 20 females aged between 10 months and 17 years.) ECG, transthoracic echocardiography, and CXR were performed in all the patients. We defined chelation adequacy as deferoxamine use≥ 4 days/week (optimal) or