Ischemia or Non-ST Elevation Myocardial Infarction (NSTEMI): This is often the first consideration for T wave abnormalities, especially in the inferior leads, as it can indicate myocardial ischemia or infarction.

Hypokalemia: Low potassium levels can cause various ECG changes, including T wave flattening or inversion, which might be more pronounced in the inferior leads.
Hypomagnesemia: Similar to hypokalemia, low magnesium levels can affect the ECG, leading to T wave changes.
Digitalis Effect: Patients on digitalis (digoxin) can exhibit T wave changes, including inversion, as a therapeutic effect of the medication.
Inferior Ischemia due to Coronary Artery Disease: This could be due to atherosclerotic disease affecting the right coronary artery, which often supplies the inferior wall of the heart.

Acute Coronary Syndrome (ACS) with ST Elevation Myocardial Infarction (STEMI) in Evolution: Early signs of an inferior STEMI might initially present with T wave inversion before progressing to ST elevation.
Pulmonary Embolism: While more commonly associated with right ventricular strain patterns, a large pulmonary embolism can cause inferior T wave inversions due to acute right heart strain.
Cardiac Contusion or Trauma: Blunt trauma to the chest can cause myocardial contusion, which might present with ECG abnormalities, including T wave changes.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This condition can lead to fibrofatty replacement of the right ventricular myocardium and might present with inferior T wave inversions among other ECG changes.
Brugada Syndrome: Although more commonly associated with ST elevation in the right precordial leads, some forms of Brugada syndrome can present with T wave abnormalities in the inferior leads.
Myocarditis: Inflammation of the myocardium can cause various ECG changes, including T wave inversions, which might be seen in the inferior leads depending on the area of the heart affected.