Pradhan, ATamrakar, PBhandari, JMahat, P2026-01-272026-01-272025https://hdl.handle.net/20.500.14572/4403Pradhan A, Tamrakar P, Bhandari J, Mahat P Department of General Practice and Emergency Medicine Karnali Academy of Health Sciences Jumla, Karnali, NepalABSTRACT Atrioventricular block and cardiogenic shock are critical complications of inferior wall myocardial infarction with high mortality, especially in resource-limited settings lacking percutaneous coronary intervention. We report a 53-year-old male smoker presenting to a rural hospital with acute chest pain, dyspnea, and profound hemodynamic instability with electrocardiogram showing inferior wall ST-segment elevation myocardial infarction with Mobitz type I atrioventricular block. This case highlights reversal of atrioventricular block with return of hemodynamic stablility using Streptokinase and ionotropes in a rural setting. Therefore, timely fibrinolysis and inotropes in managing inferior wall myocardial infarction with atrioventricular block and cardiogenic shock in percutaneous coronary intervention -inaccessible regions and strengthening rural ST segment elevation myocardial infarction care networks is crucial. KEY WORDS Atrioventricular block, Fibrinolysis, Percutaneous coronary intervention, Rural health, Shock cardiogenic, ST elevation myocardial infarctionen-USAtrioventricular blockFibrinolysisPercutaneous coronary interventionRural healthShock cardiogenicST elevation myocardial infarctionArticle