Myocardial infarction is major cause of the death and also morbidity throughout the world. Myocardial infarction may go undetected or may lead to catastrophic events leading to sudden cardiac death or causing severe haemodynamic derangements. A myocardial infarction may be the first manifestation of coronary artery atherosclerotic disease.[1] Myocardial Ischaemia is identified by history ,physical examination, and ecg findings and cardiac biomarkers. Depending on the walls of the heart effected it may be anterior ,posterior or inferior wall MI. Inferior wall MI has got some special features like right ventricular infarction and bradyarrythmias. So early identification helps in good outcome. METHODOLOGY This study was conducted during October 1st 2016 TO march 1St 2018 period . 110 consecutive patients admitted to the coronary care unit with a diagnosis of acute inferior wall infarction were included in the study. A total of 110 patients included in the study were subjected to ECG examination of V3R and V4R in addition to the conventional 12 leads. In addition, all patients were subjected to ECG examination of extended leads V7 to V9. Rhythm strips were taken in patients with arrhythmias. All patients were assessed clinically and electrocardiographically with special emphasis on presenting complaints, risk factors, vital signs, arrhythmias and mortality. Patients were followed up till discharge. RESULTS Incidence is higher in males than females, mean age is 56.6 years, most common symptom is retrosternal chest pain followed by breathlessness,palpitations.it is significantly associated with past history of diabetes mellitus, hypertension, coronary artery disease, alcohol intake and smoking. Evidence of right ventricle infarction seen in 23.7% posterior wall MI seen in 11% . CONCLUSION • All cases of inferior wall infarction should have right–sided leads during ECG examination and this should be done as early as possible. • All cases with inferior wall myocardial infarction are looked for signs of hypotension , raised JVP , bradycardia and arrythemias & conduction blocks. • If diagnosis of RVMI is correctly made and treated early, the prognosis is usually good.