Dock's murmur in LAD stenosis

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Dock’s murmur in LAD stenosis

Dock’s murmur is an early diastolic murmur heard in coronary artery stenosis. The initial documentation was using necropsy demonstration of coronary stenosis in 1967 [1]. Sangster JF et al reported 3 cases with coronary stenosis and diastolic murmur. The murmur was heard in the third left intercostal space, in a small area, about four centimeters from the midsternal line [2]. Phonocardiogram documented a crescendo-decrescendo early diastolic murmur. In their first case, a diastolic thrill was felt over the left anterior descending (LAD) coronary artery during bypass graft surgery. The murmur disappeared when the artery was fully occluded in another case. Angiography had demonstrated the absence of aortic regurgitation in these cases.
Similar murmur with echocardiographic demonstration of LAD stenosis has been reported recently [3]. Echocardiography was also useful in ruling out aortic regurgitation as a cause of the murmur.

References

  1. Dock W, Zoneraich S. A diastolic murmur arising in a stenosed coronary artery. Am J Med. I967;42:6I7-619.
  2. Sangster JF, Oakley CM. Diastolic murmur of coronary artery stenosis. Br Heart J. 1973;35:840-4.
  3. Stankovic I, Kafedzic S, Putnikovic B, Neskovic AN. An Echocardiographic Illustration of the Dock’s Murmur in a Patient With Wellens Syndrome. Can J Cardiol. 2015 Dec 29. pii: S0828-282X(15)01700-6. doi: 10.1016/j.cjca.2015.12.029. [Epub ahead of print].

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