CYANOSIS

PRESENTED BY,
SYED MOIDEEN S.A
CRMI
GMCH - ARIYALUR
TABLE OF
CONTENTS
• INTRODUCTION
• TYPES OF CYANOSIS
• SYMPTOMS
• CAUSES OF CYANOSIS
• COMPLICATIONS
• INVESTIGATIONS
• TREATMENT
INTRODUCTION
• Cyanosis is bluish hue discoloration of the skin,
mucous membrane, gums, and fingernails due to
the decreased oxygenation of the blood.
• The word cyanosis is derived from cyan,
representing a bluish-green color.
• Clinically, cyanosis is evident in cases with oxygen
saturation of 85% or less, whereas mild cyanosis
can be difficult to diagnose.
• When the absolute level of reduced
hemoglobin (Deoxyhemoglobin) in the capillary
bed exceeds 5g/DL.
or
• Increased concentration of abnormal
Hemoglobin derivatives (e.g.,
Methemoglobinemia, Sulfhemoglobinemia ) in
the superficial blood vessels.
What Does Cyanosis Look Like?

The color of the blood appears red because it is fully oxygenated.

However, when it lacks oxygen, the blood seems bluish-red or purple.

This lack of oxygen supply in the nail bed, skin, or mucous membrane
causes the body parts to take up a bluish tint.
TYPES OF CYANOSIS

CENTRAL CYANOSIS

PERIPHERAL CYANOSIS

DIFFERENTIAL CYANOSIS
 CENTRAL CYANOSIS
• Pathologic condition caused by reduced arterial oxygen saturation
(SO2).
• Involves highly vascularized tissues, such as the lips, tongue and
mucous membranes, through which blood flow is brisk and the
arteriovenous difference is minimal.
• Cardiac output typically is normal, and patients have warm
extremities.
Causes of Central
Cyanosis
• Severe pneumonia
• Mountain sickness
• Pulmonary thromboembolism
• Pulmonary edema
• Asthma
• COPD
Congenital Heart Disease
Tetralogy of Fallot
Tricuspid valve anomaly
Pulmonary valve atresia
Critical valvular pulmonary stenosis
Transposition of great arteries
Truncus arteriosus
Total anomalous pulmonary venous connection
Hypoplastic left heart syndrome
Coarctation of the aorta
Interrupted aortic arch
Critical valvular aortic stenosis
• Eisenmenger syndrome - there's increased blood pressure in the side
of the heart that has oxygen-poor blood (blue blood). The blue blood
goes through the hole (shunt) in the heart or blood vessels. Oxygen-
rich and oxygen-poor blood now mix. This causes low blood oxygen
levels
 PERIPHERAL CYANOSIS
• Normal systemic arterial oxygen saturation and increased oxygen
extraction from peripheral blood, resulting in a wide systemic
arteriovenous oxygen difference.
• The increased extraction of oxygen results from sluggish movement
of blood through the capillary circulation.
• Affects the distal extremities, and circumoral or periorbital areas .
Causes of Peripheral Cyanosis
• Raynaud’s Disease - Areas of the body feel numb and cool due to the
constriction of arteries exposed to cold.
• Hypothermia- A significant drop in body temperature.
• Heart Failure - The heart fails to pump the blood adequately.
• Deep Vein Thrombosis - Refers to a blood clot in a deep vein.
• Hypovolemic Shock - Loss of blood or other fluids makes the heart
unable to pump the blood to the body.
 DIFFERENTIAL CYANOSIS
• When cyanosis is present only in the toes but not in the fingers, it is
called Differential cyanosis. It is seen in Patent ductus arteriosus
(PDA).
A mnemonic to
differentiate
between central and
peripheral cyanosis
is: COLD PALMS
SYMPTOMS
Symptoms of Central Cyanosis:
• Bluish discoloration of tongue and
lips.
• Squatting in young children.
• Difficulty or rapid breathing
(tachypnea).
Symptoms of Peripheral Cyanosis:
• The skin appears bluish in color in the
toes, fingertips, palms, feet, or other
extremities.
• The affected extremities feel cold to
the touch.
• The color normally regains once the
extremities warm up.
• Low blood pressure.
Other Symptoms of Cyanosis Include:
• Breathlessness or shallow breathing in pulmonary edema, asthma, and
pulmonary emboli cases.
• Chest pain - in cases of cyanosis due to pulmonary embolism (a condition in
which the blockage of lung arteries is caused by a blood clot), edema (swelling
caused by excess fluid in the tissues), and pleural effusion (accumulation of
fluid between the tissues lining the lungs and the chest).
• Chest tightness - in case of cyanosis due to pulmonary edema.
• Fever - in the cyanosis due to pneumonia or pulmonary emboli.
• Dark mucus or frothy pink sputum is seen particularly in heart failure patients
associated with cyanosis.
• Thickening of the last joint of fingers gives a club-like appearance called
clubbing of fingers.
• Fatigue and headache - in patients with long-term cyanosis.
CAUSES OF CYANOSIS
Pulmonary causes
1. Alveolar hypoventilation

• Central nervous system depression: asphyxia, maternal

sedation, intraventricular hemorrhage, seizure,
meningitis, encephalitis
• Neuromuscular disease: myasthenia gravis, phrenic
nerve injury
• Airway obstruction: choanal atresia,
laryngotracheomalacia, macroglossia.
2. Ventilation/perfusion mismatch

• Airway disease: pneumonia, aspiration,

diaphragmatic hernia, lobar emphysema,
atelectasis, pulmonary hemorrhage.
• Extrinsic compression of lungs: pneumothorax,
pleural effusion, chylothorax, hemothorax,
thoracic dystrophy.
3. Diffusion impairment

• Pulmonary edema: left-sided obstructive

cardiac disease, cardiomyopathy
• Pulmonary fibrosis
• Congenital lymphangiectasia
CARDIAC CAUSES

1. Decreased pulmonary blood flow-

• Tetralogy of Fallot
• Tricuspid valve anomaly
• Pulmonary valve atresia
• Critical valvular pulmonary stenosis
CARDIAC CAUSES

2. Increased pulmonary blood flow

• Transposition of great arteries

• Truncus arteriosus
• Total anomalous pulmonary venous
connection
CARDIAC CAUSES

3. Severe heart failure

• Hypoplastic left heart syndrome

• Coarctation of the aorta
• Interrupted aortic arch
• Critical valvular aortic stenosis
Cyanosis due to abnormal
hemoglobin derivatives -
Hemoglobinopathy

1. Methemoglobinemia:
• Congenital, intake or exposure to
some drugs or chemicals, such as
sulfa drugs, nitrite salt.
• Methemoglobin >1.5 gm/dl in
blood.
2. Sulfhemoglobinemia:
• Caused by drugs or chemicals and
secondary to toxic exposure.
• Sulfhemoglobin >0.5 gm/dl in
blood.
Factors that affect cyanosis
1. Capillary factors
• Factors that increase the number of open capillaries or increase the diameters e.g.
(heat - CO2 - acid metabolites) increase the depth of central cyanosis but improve
peripheral cyanosis.
2. Skin thickness
• Cyanosis is deeper in thin skin areas.
3. Skin pigmentation
• It alters whether physiological (e.g., in yellow races) or pathological ( e.g., in
jaundice).
• In dark races Cyanosis in the skin is masked.
4. Blood composition
• The presence of abnormally great amount of Met-Hb produces a cyanotic like color.
• Other abnormalities in the blood composition also alter the depth of cyanosis (e.g.,
leukemia)
5. The amount of reduced Hb and oxyHb
• Cyanosis becomes deeper if the amount of reduced Hb is increased or the amount of
OxyHb is decreased.
COMPLICATIONS
Heart Disease: Cyanosis causes congestive heart failure and cardiac arrest.

Epiglottis: Swelling of epiglottis (a tissue flap between tongue and windpipe).

Gangrene: Dead tissue caused by lack of blood supply or infection.

Respiratory Failure: It is a condition where the lungs cannot get enough oxygen
into the blood.
Sepsis: A life-threatening condition where the body’s response to the infection
damages its own tissues.
Investigation and Diagnosis
CBC
BLOOD OXYGEN SATURATION BY PULSE OXIMETRY
CHEST X-RAY
ECG
CT CHEST
SEPSIS SCREENING
SPECTROSCOPE
BLOOD GLUCOSE CONCENTRATION
ARTERIAL BLOOD GASES (Pao2, Paco2, pH)
BLOOD CULTURES
ECHOCARDIOGRAPHY, CARDIAC CATHETERIZATION, ANGIOCARDIOGRAPHY
HEMOGLOBIN ELECTROPHORESIS
 It is a symptom of an underlying
condition rather than being a
TREATMEN disease.

T OF
CYANOSIS Treatment of cyanosis thus focus
on the Treatment of underlying
disease rather than the symptom
alone.
Symptomatic treatment of cyanosis
1. Warming of the affected areas - Peripheral cyanosis brought about
by exposure to cold or Raynaud’s phenomenon and acrocyanosis
may be treated symptomatically using gentle warming of the fingers
and toes.
2. Oxygenation as a treatment for cyanosis - Initial stabilization
requires oxygenation. Sometimes a breathing machine or ventilator
might be required.
3. Intravenous fluids - Children who have difficulty in feeding due to
cyanosis and heart failure due to an underlying cyanotic heart
disease need to be administered intravenous fluids.
4. Surgery as a treatment - Treatment of central cyanosis due to
congenital heart disease.
5. Drugs as a treatment for cyanosis – Drugs are prescribed to reduce
the excess accumulation of fluids such as Diuretics.
Cyanotic Spell

• Cyanosis is a bluish tinge, mostly

noticeable on the lips and nail beds.
During a cyanotic spell, the baby's lips
and skin will appear more blue than
usual and their breathing may be deeper
and faster. The child may initially be very
irritable, then may become grey, floppy
and unresponsive.