Causes of absent tendon reflexes:

Tendon reflex may be absent in the following situations

• Lower motor neurone disease
• Neuronal shock
• Marked spasticity and muscle contracture
• Normal individuals unable to relax

It is  seen in lower motor neuron lesions involving  any part of the reflex arc

• Lesion of the sensory nerve (polyneuritis)
• Lesion of the sensory root (tabes dorsalis)
• Lesion of the anterior horn cell (poliomyelitis)
• Lesion of the anterior root (compression)
• Lesion of the peripheral motor nerve (trauma, polyneuritis).

Before labelling as absent reflex do reinforcement
Reinforcement

Causes of Fatigue in heart disease

Fatigue  in heart disease are due to the following

• Low output state - obstructive valvular lesion - Aortic stenosis
• Pulmonary artery hypertension(PAH)
• Diffused Myocardial damage - IHD, Cardiomyopathy
• Blood volume and electrolyte imbalance -Diuretics ,Beta blocker
• Super added anxiety and depression.

Murmur in Ventricular Septal Defect (VSD)

Murmur in VSD depends on the size of VSD. Depending on the size of VSD it may produce either pansystolic murmur or early systolic murmur.

• Murmur in trivial defct à produces – high pitched early  systolic decrescendo murmur at lower left sternal border.
• Small defect produce high pitched pansystolic murmur at the LLSB.
• Moderate defect produce high pitched pansystolic murmur at the LLSB.
• Large defect produce high pitched pansystolic murmur at the LLSB.
• VSD with PAH à high pitched early systolic decrescendo murmur.
• Eisenmenger VSD  high pitched early systolic decrescendo murmur.

So VSD with early systolic murmur is heard in

1. Trivial VSD
2. VSD with PAH
3. Eisenmenger VSD

What is the basis for pansystolic murmur with midsystolic accentuation in large VSD

Rapid ejection of large stroke volume into the dilated pulmonary artery produces pulmonary flow murmur. It is the cause for midsystolic accentuation.

Read related topics

1. Development of ventricular and outflow tract separation
2. Anatomical classification of Ventricular septal defect
3. Heart sounds in ventricular septal defect
4. Murmur in Ventricular Septal Defect (VSD)
5. Development of ventricular septum
6. What are the clinical features of ventricular septal defect (VSD)?
7. Pathophysiology of ventricular septal defect (VSD)