Terminal QRS distortion

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.

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ECG Library (11)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Chest leads Anterior ST elevation Hyperacute T waves Terminal QRS distortion Normal vs. abnormal anterior ST elevation Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis.

This ECG shows ST elevation in V1-6 and hyperacute T waves out of proportion to the size of the QRS. There is terminal QRS distortion in V3. The cause was an acute proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Vomiting 12-Lead Inferior ST elevation Straightened ST segment Terminal QRS distortion Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Serial 12-lead Anterior ST elevation Hyperacute T waves Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic: 2 – En route to cath center

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This was her second ECG en route to the hospital.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Serial 12-lead Anterior ST elevation Hyperacute T waves Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic: 3 – En route to cath center

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This ECG was recorded en route to the hospital.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Serial 12-lead Anterior ST elevation Hyperacute T waves Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic: 4 – En route to cath center

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This ECG was recorded en route to the hospital.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Hyperacute T waves Late R wave transition Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This was her first prehospital ECG.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Watch what happens when “pericarditis” and morphine cloud your judgment

This ECG is from a man in his 50s who presented with chest pain on a background of prior coronary artery disease including LAD stent. This was his initial ECG.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Terminal QRS distortion Dr Smith's ECG Blog CC BY-NC
Paper published: Terminal QRS distortion not found in any ECG of Early Repolarization
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Hyperacute T waves Tall QRS Terminal QRS distortion Myocarditis Dr Smith's ECG Blog CC BY-NC
A 30 year old with Chest Pain, Anterior ST Elevation, Terminal QRS distortion, and a High Troponin