Terminal QRS distortion is a highly specific finding for occlusion of the left anterior descending artery. It can be defined as the absence of an S wave that crosses below the baseline and the absence of a J wave in lead V2 or V3.

Electrocardiographic Criteria

  • Absence of an S wave crossing below the baseline and absence of a J wave in lead V2 or V3

ECG in Terminal QRS Distortion

Electrocardiogram showing terminal QRS distortion

Terminal QRS distortion. Patient with anginal symptoms and changes in QRS morphology from V2 to V4. In V3, there is clearly no S wave crossing below the baseline and no J wave. This sign indicates acute occlusion of the left anterior descending artery.

References

  1. Lee DH, Walsh B, Smith SW. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. Am J Emerg Med. 2016;34(11):2182–5.