Dock’s murmur: Early diastolic murmur similar to that of aortic regurgitation and is heard at the left second or third intercostal space.

Dock’s murmur occurs when there is a severe stenosis of the left anterior descending coronary artery. The murmur produced is diastolic since the coronary arteries fill in diastole. It is described as early diastolic and decrescendo sounding similar to the murmur of aortic regurgitation.

Particular care should be taken if a physician finds an early diastolic murmur in a young male patient with atypical chest pain, no history of aortic regurgitation and “Wellenoid” type T-wave abnormalities. If a Dock’s murmur is found in a patient presenting with a possible Wellens syndrome, coronary flow imaging may help to diagnose and expedite management of critical LAD stenosis. 

…when he [the patient] is erect, one can record a continuous, high-pitched diastolic murmur, with striking early and late (presystolic) accentuation…a decrescendo early diastolic murmur and diamond-shaped high pitched presystolic murmur.

In this area (left of midline, third interspace), but only when he is erect, one can record a continuous, high-pitched diastolic murmur, with striking early and late (presystolic) accentuation. It seems likely this is due to a coronary A-V (atrioventricular) fistula, or a coronary anomaly with one vessel entering the pulmonary artery and retrograde flow from collaterals connecting with the normal artery.

Dock W, Zoneraich S. 1967

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U.K trained doctor currently working in ED in Perth my interests include all things acute medicine.

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Associate Professor Curtin Medical School, Curtin University. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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