Cyanosis is a condition that causes your skin, lips and nails to turn blue. This happens because there is not enough oxygen in your blood. It can be caused by many things.
Doctors diagnose cyanosis by doing a physical examination. They will also listen to your heart and lungs. They will need to take a blood sample and do other tests. These include pulse oximetry, arterial blood gas analysis, echocardiogram and cardiac catheterization.
Causes
Blue-purple skin is not normal and can be a sign of a serious medical problem. It happens when there isn’t enough oxygen in your blood to supply your body tissues and cells. This can occur when you’re cold or when there is poor circulation in your legs, arms and feet. It can also happen if you have a lung or heart condition that affects your blood flow.
Central Cyanosis
Blood with low levels of oxygen (cyanosis) shows a more bluish color because it’s carrying waste carbon dioxide back to the heart and lungs to be exhaled. The oxygen-poor blood passes through the veins and into other parts of the body, and the tissues take up the oxygen. If you have cyanosis, it’s important to get help because it may be life-threatening.
Symptoms of cyanosis include a bluish color of the lips, fingers and toes and shortness of breath. If your child has cyanosis, they may seem weak or lethargic and may not gain weight as quickly as expected. They may have a hard time breathing, cough up pink frothy sputum or dark mucus, and sometimes experience chest pain or fainting (syncope). Newborn babies with congenital cyanotic heart disease are often very ill at birth and need immediate treatment.
Peripheral Cyanosis
Peripheral cyanosis is less severe than central cyanosis. It occurs when oxygen-rich blood isn’t delivered to your limbs as it should be due to a disease or injury of the arteries, veins or lungs. This can be caused by a variety of conditions, including diabetes, atherosclerosis and peripheral vascular disease. It can also be caused by high altitudes or prolonged cold exposure.
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To evaluate a patient with cyanosis, the health care provider should perform a physical examination and listen to the heart and lungs with a stethoscope. The provider will look for abnormal heart sounds and a heart murmur. They will also test the blood for oxygen with a pulse oximeter and an arterial blood gas analysis. Other tests to diagnose a disease that causes central or peripheral cyanosis include an EKG, echocardiogram and pulmonary function tests.
Symptoms
The bluish discoloration of the skin, lips or nails is called Cyanosis. This condition is usually caused by cold weather, but it can also be a sign of other serious medical conditions. If you notice that your skin or nails look blue and they don’t return to their natural color when you warm them, seek immediate medical attention. Some cyanosis is mild and needs to be treated at home, but others require immediate treatment in the hospital.
The severity of the cyanosis depends on the cause and whether it is acute or chronic. Acute cyanosis, like that caused by Raynaud’s phenomenon, usually goes away once your hands or feet warm up. Chronic cyanosis, such as that caused by heart failure or Raynaud’s syndrome, requires long term lifestyle changes to prevent episodes of cyanosis.
People with central cyanosis have a bluish complexion due to an abnormal route of blood from the lungs to the rest of the body. This causes the deoxygenated venous blood to move into the general circulation without ever reaching the lungs for oxygenation, which then appears blue in the skin and other organs. People with central cyanosis are generally also peripherally cyanotic (blue in the hands and feet).
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Other symptoms of cyanosis may include difficulty breathing, shortness of breath, a dry cough, coughing up blood, wheezing, fainting spells and chest pains. New-born babies with cyanotic congenital heart diseases often appear floppy or limp and have a low birth weight. They can be irritable and sweaty. They tend to take shallow and rapid breaths, and sometimes make a grunting sound while breathing. They may develop repeated chest infections and have a poor appetite.
Diagnosis of cyanosis includes a physical examination and listening to your breathing and heart sounds. You will need to provide a blood sample and undergo other tests. These include pulse oximetry, arterial blood gas analysis, electrocardiogram (EKG), echocardiogram, lung function tests and cardiac catheterization. Depending on the condition causing cyanosis, treatment can range from lifestyle changes to hospitalization and surgery. If the cyanosis is severe, it can be life threatening and requires immediate medical attention.
Diagnosis
A doctor diagnosing cyanosis will take a detailed medical history, including the onset of symptoms and their duration. He or she will also perform a physical examination and examine the lips, nails, and lining of the mouth for bluish discoloration. The bluish discoloration may be harder to detect in people with darker complexions, but it is important to look for it because it can indicate that there is low oxygen in the blood. The physician will also listen to the patient’s heart and lungs and order lab work. This can include a CBC, a pulse oximetry test (which attaches a sensor to the finger or toe), arterial blood gas analysis, electrocardiogram, and echocardiogram.
The most common symptom of cyanosis is a bluish tint to the hands, feet and mouth. The color may appear as the result of peripheral vasoconstriction in cold temperatures or high altitude, or due to a condition like Raynaud’s phenomenon. Central cyanosis is more serious and can be caused by disease of the heart or lungs, or abnormal hemoglobin types such as methemoglobin or sulfhemoglobin. The patient may have difficulty breathing or feel weak, short of breath.
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In patients with severe cyanosis, the physician will need to assess how much oxygen is in the blood and may administer oxygen via mask or tube to help increase the amount of oxygen in the body. Other tests that can be done include a chest radiograph to see if there is a collapsed lung, a heparinized arterial blood sample that will change from dark red to bright red when shaken in air to check for hypoxemia, and a computed tomography (CT) scan of the heart and lungs to look for obstructions or other problems.
Depending on the underlying cause of the cyanosis, treatment will vary. People who are blue all over, for example, from low oxygen levels in the bloodstream, may need to stay in the hospital until the problem is corrected. Others may need to follow a doctor’s advice for lifestyle changes or medications. For example, some people who are cold-sensitive can treat their cyanosis by keeping their hands and feet warm. Those with chronic diseases can manage their cyanosis through medication, such as diuretics or antibiotics.
Treatment
The underlying condition that causes cyanosis must be treated to prevent complications such as hypoxia (lack of oxygen) and tissue damage. A bluish tinge in the lips, tongue or fingernails may be temporary, caused by cold temperatures causing blood vessels to constrict, resulting in reduced blood flow and oxygen supply. However, if the blue tinge in the skin persists, seek medical attention immediately. Blue lips, fingers or nails and breathing difficulties are also serious symptoms of cyanosis.
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In patients with peripheral cyanosis, warming the hands or feet usually diminishes the bluish colour because the constricted blood vessels open up and the flow of blood to the area improves. In contrast, central cyanosis remains the same or deepens despite the warming of the hands and feet because the blood flow to the area is restricted for other reasons. To determine the cause of central cyanosis, the healthcare provider must perform a physical examination and listen to the heart and lungs, as well as order some tests. These include a pulse oximetry test, which measures the amount of oxygen in the blood by attaching a sensor to the finger. Blood work such as arterial blood gas analysis, electrocardiogram and echocardiogram can also be helpful.
When cyanosis is the result of reduced oxygen delivery to the tissues, the oxygen in the blood is removed from hemoglobin and binds to other substances such as carbon dioxide and iron, producing deoxygenated hemoglobin. The deoxygenated hemoglobin gives the blood a bluish appearance. The reduced oxygen supply can be due to disease of the lungs or the heart, or to a faulty blood circulation.
Normally, red (oxygen rich) blood is delivered from the heart to the rest of the body and then returns to the heart for more oxygen. A defect in this process may lead to the blood bypassing the lungs and going directly to the systemic circulation, or to the lungs being overwhelmed by a poor blood supply. Other abnormalities can also reduce the oxygen-carrying capacity of the blood, such as a right-to-left shunt and Eisenmenger’s syndrome.
