ABSTRACT Amongst all acute myocardial infarction anterior wall myocardial infarction is the most common variant and inferior wall myocardial infarction the second most common. The aim of this study was to study the clinical features, risk factors, complications & overall mortality in acute inferior wall myocardial infarction (IWMI) admitted to a tertiary care center in PIMSR, Islampur between December 2022 to December 2023. In present study out of the total studied 100 patients 66% were male & 34% were female patients with M: F ratio 1.9:1, with mean age 57.4 years. The highest incidence was noted in 51 to 60 years age group (44%), 87% of patients had chest pain, 34% patients had sinus bradycardia & 40% had AV conduction defects. Total mortality rate was 25% with highest incidence in age group 61-70 yrs. Mortality in females was high (29.4) than males (22.6%). Mortality was highest 38.4% in patients without chest pain group. Incidence of mortality in risk factor groups out of 100 cases & out of 25 total deaths showed Tobacco users – 22.8% & 32%, Hypertension – 21.8% & 28%, Diabetes Mellitus – 34.6% & 36%, Alcohol users – 31.5% & 24% respectively. Mortality rate in relation to Killip’s class was 41.6% in class III, 75% in class IV. Incidence of atrioventricular defects & intraventricular defects was 45% & 11% with mortality rate of 26.6% & 63.6% respectively. Considering clinical presentation with no chest pain MI having high mortality, high complications & mortality rate in risk groups like Tobacco users, Diabetics & Hypertensive patients, proper educational programs are needed. Keywords: Acute, Inferior wall, Myocardial infarction, Conduction abnormalities.