A case of severe congestive cardiac failure of unidentified etiology demonstrating an extreme electrical QRS axis is presented. The axis is about -120 degrees. This electrocardiographic manifestation is rare, and, to the best of our knowledge, there have been no previously reported cases in congestive cardiac failure in our environment. This finding, in view of the clinical state of our patient, may be indicative of extreme severity resulting in widespread patchy myocardial fibrosis.