The modern drainage systems of the fold and thrust belt of the external Hellenide orogen of NW Greece are principally orogen-parallel. Late Quaternary changes in river courses have resulted from neotectonic deformation associated with the Katouna–Stamna fault and with footwall uplift in developing transverse grabens. This study assesses the impact of neotectonic deformation on river patterns and basin deposition. River sands show differences in modal abundance and varietal geochemistry of heavy minerals and fine sand lithic clasts, determined by scanning electron microscope, that allow identification of past river supply to raised fluvial terrace and beach deposits. In the past 200 ka, footwall uplift south of developing grabens at Lake Trichonis and the Amvrakikos Gulf promoted orogen-transverse flow, diverting the Arachthos-Louros rivers to the west, causing reversal of drainage to the north in the lower reach of the Acheloos River. A raised terrace gravel south of Preveza records the southwestward flow of a large paleo-Arachthos river, confirmed by sand petrology in beaches farther south on the Echinadon Sea coast. The use of varietal heavy minerals and lithic clasts is a rapid and powerful tool for tracking tectonically-induced changes in river patterns.