Inferior wall myocardial infarction stems from ischemia and necrosis due to occlusion of the right coronary and/or distal circumflex arteries that supply this area of the heart. The clinical presentation most commonly encompasses chest pain that often spreads to other parts of the body (the extremities, the back, or the head and neck), whereas an array of additional symptoms can be present - nausea, vomiting, diaphoresis, palpitations, weakness, etc. The diagnosis rests on a prompt clinical assessment followed by a laboratory investigation with electrocardiography.
The clinical presentation of an inferior wall myocardial infarction is no different from other types of infarctions. Occlusion of the arterial vessel (the right coronary and the distal circumflex arteries supply the inferior myocardial wall) leads to ischemia and subsequent necrosis of local tissue, resulting in the appearance of signs . Chest pain is widely described as the predominant finding in the setting of a myocardial infarction and is present in virtually all patients   . The pain (generally located retrosternally or precordially) is reported as "burning" or as a heavy "squeezing" pressure on the chest, lasting > 20 minutes in more than 90% of cases . An important feature of chest pain seen in myocardial infarction is its frequent radiation to other parts of the body - the head and neck area (particularly the jaw), the shoulders, arms and forearms; and the back and interscapular region, either in a unilateral or less commonly bilateral fashion  . The pain may significantly range in terms of severity- some report only mild discomfort, whereas others complain of excruciating pain  . Important additional symptoms are vomiting, nausea, weakness, fatigue, shortness of breath, excessive sweating, abdominal pain, or even palpitations  .
Myocardial infarction is a medical emergency and a prompt diagnosis is potentially life-saving. Through a detailed patient history and a comprehensive clinical examination, the physician plays a key role in raising initial suspicion. The onset of signs, as well as their progression and severity, should be assessed during the initial encounter with the patient. To make a solid diagnosis, however, two important steps of the workup should be covered - cardiac markers and electrocardiography     . The calcium-dependent troponins are currently regarded as the most specific test used to identify myocardial changes    . Troponins T and I are cardiac-specific markers that are pathologically elevated about 6 hours after myocardial ischemia ensued, while their peak values are seen about 24 hours after the event . Creatine kinase myocardial band (CK-MB), on the other hand, was until recently included in the biochemical panel, but its very low accuracy and value to physicians have led to its elimination from the workup of these individuals . On electrocardiography, inferior myocardial infarction exhibits pathological changes in limb leads II, III, and aVF, in the form of ST elevation or depression, and/or T wave inversion in 2 contiguous leads as diagnostic criteria   . Coronary angiography can be further used to assess the severity of the infarction .