V.

SOWNDHARYA MEERA
 Cyanosis is a condition characterised
by bluish discolouration of skin and
mucous membrane resulting from
increased amount of reduced
haemoglobin or its derivatives in
capillaries.
 Normally in arterial blood 95% of
Hb is saturated with O2 whereas in
venous blood it is only 70%.

 Hence in capillaries the mean reduced

Hb is 5% to 30% and so the skin
and mucous membrane appears pink.
 Due to decreased arterial saturation
or increased extraction of oxygen
from sluggish movement of blood.
Decreased arterial saturation is due to
1. Cyanotic congenital heart
diseases
2. left heart failure
3. impaired alveolar functions
4.Abnormal haemoglobins
Increased extraction of oxygen is due
to
1.Venous obstruction
2.Arterial obstrution
3.Reduced cardiac output
4.Peripheral vasoconstriction
Based on the causes cyanosis may be
1. Central cyanosis.
2. Peripheral cyanosis.
3. Mixed cyanosis
4. Differential cyanosis.
5. Enterogenous cyanosis.
-Due to decreased arterial saturation
resulting from
1.High altitude(due to low partial ressure
of O2)
2.Cyanotic congenital heart diseases
3.Eisenmenger syndrome
4.Left heart failure
5.Acute severe asthma
6.Respiratory failure, COPD, Cor
pulmonale
7.Pulmonary AV fistula
 SITES TO BE LOOKED FOR
 Tongue(margins and undersurface)
 Lower palpebral conjuctiva
 Inner aspect of lips
 Mucous membrane of
gum,palate,cheeks
 Due to increased extraction of oxygen resulting
from
1. exposure to cold air or water
2. congestive cardiac failure
3. shock
4. venous obstruction
5. arterial obstruction
6. mitral stenosis
7. cryoglobulinemia
8. septicaemia
 SITES TO BE LOOKED FOR
Nose tip
Ear lobules
Outer aspect of lips,chin,cheek
Tip of finger and toes
Nailbeds
Palms and soles
Seen in

 CCF
 Acute MI with LVF
 Hands red and feet blue- PDA with
reversal of shunt
 Hands blue and feet red- COA with
TGV
 Due to the presence of excess sulphaemoglobin
or methaemoglobin.
 Causes includes
Heriditary Hb disease
Anilne poisoning
Drugs- nitrates, phenacetin, sulphonamides,
dapsone
 Cyanosis
 Argyria
ALSO LOOK FOR
 Clubbing
 Peripheral
pulsations
 RS examination
 CVS examination
 History and complete examination
 INVESTIGATION
Pulse oximetry
ABG
ECG
Chest X-RAY
 TREATMENT
O2 supplementation
Management of underlying cause.