Terminal QRS distortion occurs when there is ST elevation and neither an S wave nor a J wave is present. This applies to either lead V2 or V3. This may suggest that LAD occlusion is more likely than normal variant early repolarisation. This sign is not well known and can be missed.
See also: QRS shapes
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- Miranda, DF et al. (2018) - New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department, Canadian Journal of Cardiology vol 34(2):132-145 (Accessed: 24/08/2019)
This ECG is from a man in his 60s who presented with chest pain radiating to the back and nausea/vomiting. He had a history of previous MI and stents.
This ECG shows inferior ST elevation (straightened ST segments) without reciprocal changes, with terminal QRS distortion in inferior leads. The cause was an inferior MI with some posterior involvement.