Background: When compared to cases who had isolated inferior infarctions, those with right ventricular infarctions that occur alongside inferior infarctions had greater odds of bradycardia or severe hypotension, needing pacing support, with higher in-hospital rate of death. Objective: The aim of the current study to evaluate pulsed wave TDI role together with other Conventional Echo-Doppler modalities in the right ventricular (RV) function assesement among acute inferior ST elevation myocardial infarction (STEMI) associated with RV infarction. Patients and methods:A two arm, single blinded randomized controlled clinical trial was performed on 100 cases, presenting with acute inferior myocardial infarction (MI) associated with RV infarction, during the period from January 2020 to July 2022. Patients were divided into two groups; Group A involved 50 cases who underwent coronary angiography and primary percutaneous coronary intervention (PCI), while Group B involved 50 cases who received thrombolytic therapy. Results: Patients who had undergone primary PCI showed highly significant improvement of RV systolic function, in comparison with patients who received thrombolytic therapy. In comparison to Group B (TT), Group A (PPCI) showed a significant higher S' (14.19±1.77cm/s vs. 10.01±2.66cm/s, P<0.001) and longer ET (285.41±38.83ms vs. 233.82±51.47ms, P<0.001), while isovolumetric times (IVCT and IVRT) were significant lower in Group A versus Group B (62.80±13.68ms vs. 79.53±16.26ms, P<0.001; 64.43±19.07ms vs. 80.73±19.20ms, P<0.001, respectively).Conclusions: Primary PCI is superior to thrombolytic therapy in terms of improvement of RV function where pulsed wave TDI is a more sensitive diagnostic tool of RV infarction.