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| {{Infobox_Disease | | | __NOTOC__ |
| | Name = Cyanosis
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | {{Cyanosis}} |
| | ICD10 = {{ICD10|R|23|0|r|20}}
| | {{CMG}}; {{AE}} {{Sara.Zand}} {{ADS}}, {{CK}} |
| | ICD9 = {{ICD9|782.5}}
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| {{SI}} | |
| {{CMG}} | |
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| == Overview == | | ==[[Cyanosis overview|Overview]]== |
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| '''Cyanosis''' is a bluish coloration of the [[skin]] due to the presence of deoxygenated [[hemoglobin]] in [[blood vessel]]s near the skin surface. It occurs when the [[oxygen saturation]] of arterial blood falls below 85%.
| | ==[[Cyanosis historical perspective|Historical Perspective]]== |
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| The elementary principle behind cyanosis is that deoxygenated hemoglobin produces the bluish discoloration, and also produces vasoconstriction that makes it more evident. Thus oxygen deficiency - [[Hypoxia (medical)|hypoxia]] - leads to blue discoloration of the lips and other mucus membranes.
| | ==[[Cyanosis classification|Classification]]== |
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| ==Etymology== | | ==[[Cyanosis pathophysiology|Pathophysiology]]== |
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| The name is derived from the color cyan, the greek word for blue.
| | ==[[Cyanosis causes|Causes]]== |
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| ==Types== | | ==[[Cyanosis differential diagnosis|Differentiating Cyanosis from other Diseases]]== |
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| '''Cyanosis''' can occur in the [[finger]]s, including underneath the [[nail (anatomy)|fingernails]], as well as other extremities (called ''peripheral cyanosis''), or in the [[lip]]s and tongue (''central cyanosis'').
| | ==[[Cyanosis risk factors|Risk Factors]]== |
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| == Central cyanosis == | | ==[[Cyanosis screening|Screening]]== |
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| Central cyanosis is often due to a circulatory or ventilatory problem that leads to poorer blood [[oxygenation]] in the lungs or greater oxygen extraction due to slowing down of blood circulation in the skin's blood vessels.
| | ==[[Cyanosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| === Differential Diagnosis of Central Cyanosis === | | ==Diagnosis== |
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| * [[Abnormal hemoglobin]]
| | [[Cyanosis diagnostic study of choice|Diagnostic Study of Chocie]] | [[Cyanosis history and symptoms|History and Symptoms]] | [[Cyanosis physical examination|Physical Examination]] | [[Cyanosis laboratory findings|Laboratory Findings]] | [[Cyanosis electrocardiogram|Electrocardiogram]] | [[Cyanosis chest x ray|Chest X Ray]] | [[Cyanosis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cyanosis CT|CT]] | [[Cyanosis MRI|MRI]] | [[Cyanosis other imaging findings|Other Imaging Findings]] | [[Cyanosis other diagnostic studies|Other Diagnostic Studies]] |
| * [[Acute respiratory distress syndrome]]
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| * [[Alveolitis]]
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| * [[Atelectasis]]
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| * [[Atrial septal defect]]
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| * [[Bronchiectasis]]
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| * Central or peripheral respiratory paralysis
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| * Chronic [[bronchitis]]
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| * [[Congenital heart disease]]
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| * Decreased respiration with oversedation
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| * [[Double outlet right ventricle]]
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| * [[Emphysema]] <br>
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| * Foreign-body [[aspiration]]
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| * [[High altitude exposure]]
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| * [[Hypersensitivity pneumonitis]]
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| * [[Intoxication]]
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| * Intrapulmonary arteriovenous aneurysms
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| * [[Lung cancer]]
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| * [[Mediastinitis]]
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| * [[Patent ductus arteriosus]]
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| * [[Pickwickian syndrome]]
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| * [[Pleural Effusions]]
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| * [[Pneumoconiosis]]
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| * [[Poliomyelitis]]
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| * [[Polyneuropathy]]
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| * [[Primary alveolar hypoventilation]]
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| * Pulmonary arteriovenous fistulas
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| * [[Pulmonary edema]]
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| * [[Pulmonary embolism]]
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| * [[Pulmonary fibrosis]]
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| * [[Pulmonary hypertension]]
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| * Severe [[chronic obstructive pulmonary disease]] ([[COPD]]) or [[asthma]]
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| * Severe [[pneumonia]]
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| * Single ventricle
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| * [[Sleep apnea]]
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| * Tension [[pneumothorax]]
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| * [[Tetralogy of Fallot]]
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| * Toxins/poisons <br>
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| * [[Transposition of the great vessels]]
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| * [[Tuberculosis]]
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| * [[Ventricular septal defect]]
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| == Peripheral cyanosis == | | ==Treatment== |
| | | [[Cyanosis medical therapy|Medical Therapy]] | [[Cyanosis surgery|Surgery]] | [[Cyanosis primary prevention|Primary Prevention]] | [[Cyanosis secondary prevention|Secondary Prevention]] | [[Cyanosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Cyanosis future or investigational therapies|Future or Investigational Therapies]] |
| Peripheral cyanosis is the blue tint in fingers or extremities, due to inadequate circulation. The blood reaching the extremities is not oxygen rich and when viewed through the skin a combination of factors can lead to the appearance of a [[Blood#Color|blue color]]. All factors contributing to central cyanosis can also cause peripheral symptoms to appear, however peripheral cyanosis can be observed without there being heart or lung failures. Small blood vessels may be restricted and can be treated by increasing the normal oxygenation level of the blood.
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| === Differential Diagnosis of Peripheral Cyanosis ===
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| * [[Ddx:Acrocyanosis|Acrocyanosis]]
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| * Arterial [[embolism]]
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| * [[Arrhythmia]]
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| * [[Cardiomyopathy]]
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| * [[Cold exposure]]
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| * [[Congenital Heart Disease]]
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| * [[Congestive Heart Failure]]
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| * [[Endomyocardial fibrosis]]
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| * [[Heart tumors]]
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| * [[Hypertensive heart disease]]
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| * [[Mitral Stenosis]]
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| * [[Pericardial effusion]]
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| * [[Polycythemia vera]]
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| * [[Raynaud's Phenomenon]]
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| * [[Shock]]
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| * [[Superior vena cava obstruction]]
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| * [[Valvular disease]]
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| * Venous hypertension
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| * [[Venous stasis]]
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| ==Differential Cyanosis==
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| In adults with a large [[PDA]], [[Eisenmenger's syndrome]] may develop with presents as cyanosis due to a [[right-to-left shunt]]. The inversion of the shunt is produced because of the progressive increase in [[pulmonary vascular resistance]]. Severe [[pulmonary vascular resistance]] results in reversal of flow through the ductus, and unoxygenated blood is shunted to the descending [[aorta]], and the toes, but not the fingers, become cyanotic and clubbed, a finding termed differential cyanosis.
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| == Diagnosis ==
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| === Physical Examination ===
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| === Heart ===
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| Check for [[murmurs]] of congenital or acquired [[valvular heart disease]]
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| === Lungs ===
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| Careful auscultation for lung pathology
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| === Extremities ===
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| * Pulses in all extremities need to be evaluated.
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| * Check capillary refill.
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| * [[Clubbing]] of the toes or fingers may be indicative of chronic pulmonary disease or [[congenital heart disease]].
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| === Laboratory Findings ===
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| * [[Complete blood count]] ([[CBC]])
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| * [[Glucose]]
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| * [[Arterial blood gas]]
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| * [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
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| * [[Pulse oximetry]]
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| === Electrolyte and Biomarker Studies ===
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| === Electrocardiogram ===
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| * [[ECG]] is indicated for diagnostic purposes
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| === Chest X Ray ===
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| * [[X-ray]] of chest can determine the size of the heart and lung pathology
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| === MRI and CT ===
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| * Possible [[CT scan]] can determine the size of the heart and lung pathology
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| === Echocardiography or Ultrasound ===
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| * To rule out structural abnormalities and to assess ventricular function and valves, an [[echocardiogram]] are recommended
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| === Other Imaging Findings ===
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| * [[Angiogram]] and [[pulmonary angiogram]]
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| === Other Diagnostic Studies ===
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| * [[Pulmonary function test]]s
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| * Arterial doppler studies
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| * [[Cardiac enzymes]]
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| * [[Hemoglobin electrophoresis]]
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| * Ventilation and Quantitative (V/Q) scan
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| == Treatment ==
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| * Supplemental oxygen is needed for all patients
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| * Mechanical ventilation and intubation for respiratory support may be indicated
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| * Underlying etiologies, and patients in shock need to be treated as clinically indicated
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| === Acute Pharmacotherapies ===
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| * Patients in [[congestive heart failure]] may need a diuretic or [[afterload]] reduction
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| ==Sources==
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| #Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:39
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| #Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:91-92
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| #Raftery, Andrew, Lim, Eric. Churchill's Pocketbook of Differential Diagnosis. London, UK: Elsevier Limited, 2005:95-97
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| ==References==
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| {{Reflist|2}}
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| {{Skin and subcutaneous tissue symptoms and signs}}
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| | ==[[Cyanosis case study one|Case #1]]== |
| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| | [[Category:Medical signs]] |
| | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Physical Examination]] | | [[Category:Physical Examination]] |
| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
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