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CYANOSISBY DR NAGANATH NARASIMHAN PREM
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Defnition
It is defned as the bluish discoloration othe sin and the !ucous !e!branes"resultin# ro! an increase in the reduced
Haemoglobin or o hae!o#lobinderi$ati$es in the s!all $essels o thoseareas%
&'anosis is deri$ed ro! the colour (c'an)"*hich co!es ro! ('anous)" the Gree *ordor blue%
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Sites to detect c'anosis
+i,sNail beds
Ears
Malar Pro!inences
Pal!s and Soles
Ton#ue
Mucous !e!branes o #u!"sot
,alate"chees
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-actors alterin# c'anosis
&olour o the cutaneous ,i#!ent
Thicness o the sin
State o cutaneous ca,illaries
&'anosis beco!es a,,arent *hen theconcenteration o the reduced hae!o#lobinin ca,illar' blood $essels e.ceeds 40 g/l or
4g/dl
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T',es o &'anosis&entral &'anosis
Peri,heral &'anosis
Mi.ed &'anosis
/ther T',es
Entero#enous0Pi#!ent &'anosis
Di1erential &'anosis
Acroc'anosis
/rthoc'anosis
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&entral &'anosis23Decreased arterial o.'#en saturation
Decreased at!os,heric ,ressure3Hi#h altitude
I!,aired ,ul!onar' unction
Al$eolar h',o$entilation
Pul!onar' $entilation ,erusion i!balanceI!,aired o.'#en di1usion
Anato!ic Shunts 4ASD"5SD"PDA
&on#enital Heart Diseases3-allots Tetrolo#'"TGA
Pul!onar' A5 fstulas
Muti,le s!all intra,ul!onar' shunts
Hae!o#lobin Abnor!alities
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Mechanis!Decreased arterial o.'#en saturation due to!ared decrease in o.'#en tension in thearterial blood6arterial Pa/7 is reduced8
Sites-
Ton#ue 6!ar#ins 9 undersurace8
Inner as,ect o li,s
Mucous !e!branes o #u!s"sot,alate"chees
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Peri,heral &'anosisDecreased &ardiac /ut,ut
&old E.,osure
Redistribution / blood ro! e.tre!ities
Arterial /bstruction3e!bolus"ra'nauds
,heno!enon5enous /bstruction3thro!bo,hlebitis"S5&
s'ndro!e
-rost bite
&&-"shoc"Peri,heral &irculator' -ailureH',er$iscosit' 3Multi,le
!'elo!a"Pol'c'the!ia
Peri,heral 5ascular Diseases3atherosclerosis"buer#er)s
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Mechanis!
Arterial blood saturation nor!al"but o.'#enunsaturation at $enous end o ca,illar'
• Reduced cardiac out,ut3:,eri,heral$asoconstriction3:slo* s,eed o circulation
in e.tre!ities• Sites
• Ti, o nose
• Ear lobules
• /uter as,ect o li,s"chin"chee
• Ti,s and nailbeds o fn#ers"toes
• Pal!s"soles
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Mi.ed &'anosis
&ardio#enic shoc; ,ul!onar' oede!a&&- due to lt%sided heart ailure
Pol'cthe!ia 6rare8
/rthoc'anosis
Present in u,ri#ht ,osition due to h',o.iaoccurin# in erect ,osture in Pul!onar'Arterio$enous Malor!ation
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Entero#enous0,i#!ent c'anosisDue to ,resence o e.cessi$e 4
sul,hae!o#lobin6:
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Di1erential &'anosis
Hands red 6less blue8 and eet blue seen inPDA *ith re$ersal o shunt 6Di1erential&'anosis8
+ R
shunt
Pul!onar'h',ertension
R to +
Re$ersalo shunt
Desaturated blood from theductus enters the aorta distal
to the left subclavian artery,sparing the brachiocephalic
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Hands blue and eet red seen in &oarctationo Aorta *ith TGA6Re$erse Di1erential&'anosis
Inter!ittent &'anosis seen in Ebstein)sAno!al'
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en ra s er , era&'anosis SITES TONGUE,ORAL
CAVITY TONGUEUNAECTE!
HANDSHA?E -EE+S @ARM -EE+S &/+D
APP+I&ATI/N /-@ARMTH"&/+D N/ &HANGE @ARMTH3&YAN/SISIN&R"&/+D3DE&REASES
APP+I&ATI/N PRE/7
MAY IMPR/5E N/ RESP/NSE
&+BBING"P/+Y&YTHAEMIA
SA++Y PRESENT ABSENT
P+SE 5/+ME MAYBE HIGH +/@ 5/+
DYSPN/EA PT BREATH+ESS N/ RESPIRAT/RY
PR/B+EM
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Acroc'anosis&ondition in *hich there is arterial
$asoconstriction"and secondar' dilation oca,illaries and $enules *ith resultin#,ersistant c'anosis o the hands and lesseuentl' the eet%
Pri!ar'
Secondar'
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A,,roach to a ,atient *ith &'anosis
Ti!e and onset o c'anosis"Birth 0inanc'usuall' con#enital heart diasease%
Di1erentiation o &entral and Peri,heral&'anosis $er' i!,ortant
&lubbin# ,resence0abscense noticedPeri,heral c'anosis clubbin# absent
Pa/7 and Sa/7 should be deter!ined in,atients *here in !echanis! is obscured%
S,ectrosco,ic E.a!ination to be done
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&'anosis
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Psuedoc'anosisBluish tin#e to the sin and or !ucous
!e!branes that is not associated *ith eitherH'o.e!ia or Peri,heral 5asoconstriction
Metals
Dru#s
