diease

Cyanosis


OVERVIEW OF Cyanosis :

 Cyanosis refers to the bluish discoloration of the skin and the mucous membrane.

It occurs due to the inadequate supply of oxygen to the tissues.

Sometimes cold temperatures can cause blood vessel narrowing and lead to temporarily blue-tinged skin. Warming or massaging the blue areas should return normal blood flow and colour to the skin.


CAUSES :

Venous insufficiency caused by conditions that slow blood flow through your veins.

Too tight clothing

Deep vein thrombosis

Raynaud’s phenomenon

Lymphedema

Heart failure

Arterial insufficiency caused by conditions that slow blood flow through the arteries

Severe hypotension or extremely low blood pressure which might caused by conditions such as septic shock.

Hypovolemia which is termed as the reduced flow of blood throughout the body.

Respiratory disorder

Lung disorder

Types of Cyanosis:

There are two types of cyanosis:

Central Cyanosis:

Central cyanosis is caused by disease of the heart or lungs or by abnormal haemoglobin types like methemoglobin or sulfhemoglobin. The manifestation is seen as bluish or purple discoloration of tongue and linings of the mouth.

There may be concomitant peripheral cyanosis.

Fingers and toes are warm to touch. There may be other features like breathlessness, shallow breathing, rapid breathing.

Peripheral Cyanosis:

It results from decreased local blood circulation in the peripheral organs, arms and legs. The arterial blood stagnates too long in the limbs and loses most of its oxygen.

The levels of deoxygenated blood rises in the small blood vessels of eh fingers and toes. This might result in the heart failure, shock, exposure to cold temperatures and diseases of blood circulation.

Limbs appears bluish and are usually cold to touch. Peripheral cyanosis is most intense in nail beds. Warming may resolve the cyanosis.

Circumoral Cyanosis:

Cyanosis is a condition where there is bluish discoloration of the skin due to decreased oxygenation or blood circulation. Circumoral cyanosis is a condition where there is bluish discoloration or a bluish tint on the skin surrounding the lips. 


PATHOPHYSIOLOGY :

In order for circulating blood to appear blue, it requires an elevated amount of blue pigment to accumulate. Central cyanosis is generally of greater concern, as it requires reduced arterial oxygen saturation (PaO2)  or abnormal derivatives of hemoglobin can be present(methemoglobin or silfhemoglobin) and it is the delayed finding in the course of illness.  The increased amount of deoxygenated hemoglobin is due to an increased amount of venous admixture (due to vasodilatory effects on the venous plexi) or by reduced  arterial oxygen tension in the capillaries.

 In central cyanosis, either SaO2 is reduced or abnormal (nonfunctional) hemoglobin is present, which is why central structures and mucosae are affected; this is in contrast to peripheral cyanosis, where there is a normal SaO2 but increased extraction of oxygen in the setting of peripheral vasoconstriction and thus, decreased peripheral blood flow. As McGee1 astutely notes, historically there has been (and exists still in the teaching of medical students today) great confusion about the actual levels of deoxyhemoglobin required to produce clinically apparent cyanosis. This is because many clinicians erroneously equate arterial levels of deoxyhemoglobin with capillary levels—and it is the capillary levels, not the arterial ones, that yield the blue color we observe. Another important point is that it is the absolute, not relative, quantity of deoxygenated hemoglobin that matters; this means that for a given patient, the level of SaO2 at which cyanosis becomes apparent depends on their total hemoglobin concentration. Because of this, severely anemic patients with marked arterial desaturation might not be cyanosed, yet polycythemic patients develop obvious cyanosis at much higher SaO2  associated conditions


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Chest muscles pulling in with every breath or flaring nostrils with breathing
  • Difficulty breathing or rapid breathing
  • Fussiness or irritability
  • Grunting
  • Limpness or lethargy
  • Poor feeding or sleeping
  • Sitting very still with shoulders hunched


DIAGNOSTIC :

Bluish skin is usually a sign of something serious. If normal color does not return when the skin is rubbed or warmed it is vital to seek the medical help.

Arterial Blood Gas Test: It measures the acidity and levels of carbon dioxide and oxygen in the blood.

Electrocardiogram: It is taken to completely the rule out the prevalence of cardiac abnormalities.

Chest X ray: It is taken to rule out the conditions like pneumonia, pulmonary infarction and cardiac failure.

Ventilation Perfusion Scan or Pulmonary Angiography: It is taken to rule out the pulmonary causes.

Echocardiography: It is used to look for the presence of any cardiac defects.

Haemoglobin Spectroscopy: The spectroscopy checks for the methemoglobinemia or sulfhemoglobinemia.

Digital Subtraction Angiography: It is done to completely rule out conditions like acute arterial occlusion.

Doppler or venography:

A duplex doppler or Venography can detect the prevalence of acute venous occlusion.


TREATMENT AND PROGNOSIS :

Warming of the Affected Areas:

Peripheral cyanosis is brought by the Raynaud’s phenomenon and acrocyanosis may be treated symptomatically using gentle warming of fingers and toes.

Surgery as a treatment for Cyanosis:

Treatment of central cyanosis is due to congenital heart defects may often involve surgery.

The therapy of Tetralogy of Fallot (TOF) needs surgery soon after birth. If the symptoms as less severe surgery may be performed at the age of three to six months.

Open heart surgery is usually used to treat TOF. The defects of the heart valves are corrected during the surgery.

Oxygenation as a treatment for Cyanosis:

Initial stabilization requires oxygenation. Sometimes ventilator or breathing machine can be used.

If any obstruction is detected an endotracheal tube is inserted and oxygen is administered through it.

Intravenous Fluids:

Children who has difficulty in feeding due to cyanosis and heart failure due to an underlying cyanotic heart disease need to be administered intravenous fluid.

Drug as a treatment for Cyanosis:

In patients with cardiac failure diuretics are preferred to reduce the excess accumulation of fluids which are termed as Diretics.

Cardiac Failure Patients:

Heart failure patients and those with cyanotic heart disease need drugs that help the heart pump harder. Antibiotics are prescribed to prevent from infections and also to treat Pneumonia.

Some patients might require pacemaker for the heart for prolonged period of time.

Injections for babies with cyanosis:

If the baby is born with the Transposition of the Great Arteries(TAG) as a cause of cyanosis at birth an injection of mediaction called prostaglandin is given shortly after the birth.

The right side of the heart contains deoxygenated blood and left side of the heart contains the oxygenated blood supply. When this TGA crisis occurs it might result in the intermixing  of the blood leading to the improper supply of the blood to the heart and result in cyanosis .

This prevents the closure of ductus arteriosus which prevents the blood passing from aortic and pulmonary valve.

Some prostaglandin might work in these patients.

Some needs open heart surgery to close the valve.

Glucose administration:

Cyanosis due to other causes like low blood suger level can be manged by glucose infusions and glucose administrations.

There are certain medications which relaxes the blood vessels:

  • antidepressants
  • antihypertensive drugs
  • erectile dysfunction drugs

 


PREVENTION :

Follow healthy lifestyle

Do physical activities

Avoid cold environments when not able to adapt

Cessation of smoking
 


REFERENCE :

References:

https://www.news-medical.net/health/Treatment-of-cyanosis.aspx

https://www.medicalnewstoday.com/articles/188939#treatment

https://www.narayanahealth.org/cyanosis/

https://www.uptodate.com/contents/overview-of-cyanosis-in-the-newborn

https://www.epainassist.com/chest-pain/lungs/circumoral-cyanosis?gclid=CjwKCAjw0qOIBhBhEiwAyvVcfweLsr5aPhq6OIj074zSjuk3mjwp8L8_q8MCKzGwttZ-lw8B7VYQfhoCShkQAvD_BwE