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==Overview== | ==Overview== | ||
The [[hallmark]] of [[cyanosis]] is blue discoration of [[skin]] and [[mucous membrane]]<nowiki/>s. Obtaining the [[History and Physical examination|history]] is most important aspect because of its association with wide variety of disorders ([[Heart|cardiac]], [[Lung|pulmonary]], [[vascular]], [[Neurology|neurologic]] and [[Neuromuscular disease|neuromuscular disorders]]). [[History and Physical examination|History]] taking also provide clues to specific [[Etiology| | The [[hallmark]] of [[cyanosis]] is blue discoration of [[skin]] and [[mucous membrane]]<nowiki/>s. Obtaining the [[History and Physical examination|history]] is most important aspect because of its association with wide variety of disorders ([[Heart|cardiac]], [[Lung|pulmonary]], [[vascular]], [[Neurology|neurologic]] and [[Neuromuscular disease|neuromuscular disorders]]). [[History and Physical examination|History]] taking also provide clues to specific [[Etiology|causes]], precipitating factors and associated [[Comorbidity|comorbid conditions]]. | ||
==History and Symptoms== | ==History and Symptoms== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
The hallmark of cyanosis is blue discoration of skin and mucous membranes. Obtaining the history is most important aspect because of its association with wide variety of disorders (cardiac, pulmonary, vascular, neurologic and neuromuscular disorders). History taking also provide clues to specific causes, precipitating factors and associated comorbid conditions.
History and Symptoms
Cyanosis is a symptom of a disease process.Obtaining history is the most important aspect of making a diagnosis of diseases associated with cyanosis. It provides insight into the cause, precipitating factors, and associated comorbidities. A complete history will help determine the correct diagnosis, therapy, and the prognosis. Specific histories including symptom onset, pre-existing lung diseases, congenital heart diseases, the presence of CNS lesions, associated symptoms, and drug usage have to be obtained.
History
- Timing of onset of cyanosis[1][2][3][4]
- congenital: Onset of cyanosis in early neonatal period is suggestive of congenital etiology (eg, congenital heat diseases with right to left shunts, congenital airway anomalies).
- Acquired: Recent onset is suggestive of acquired etiology (eg, pulmonary embolus, pneumonia, asthma, cardiac failure).
- Duration and frequency
- History of prior lung disease:[5][6]
- Exacerbation of pre-existing lung diseases (eg, Asthma, COPD, interstitial lung diseases) can cause respiratory distress and lead to cyanosis.
- History of congenital heart diseases:[7][8]
- Congenital heart disease present with profound central cyanosis in the early neonatal period.
- Left-side obstructive lesions:
- Right-sided obstructive lesions:
- Tetralogy of Fallot,
- pulmonary atresia with intact ventricular septum
- Tricuspid valve anomalies (tricuspid atresia, Ebstein's anomaly)
- Critical pulmonary valve stenosis
- Transposition of the great arteries
- Truncus arteriosus
- Total anomalous pulmonary venous connection
- Congenital heart disease present with profound central cyanosis in the early neonatal period.
- Exposures:
- History of smoke inhalation and asphyxiating gases.
- History of exposure to low oxygen environments[9] (eg, carbon monoxide poisoning, hydrogen cyanide poisoning).
- History of trauma:
- Motor vehicle collisions
- External chest compression
- History of trauma to upper airway and chest wall (eg, Flail chest, upper airway fractures, pneumothorax, hemothorax).
- History of neurologic disease:
- Any neurologic condition that results in respiratory distress can cause cyanosis (eg, seizures, central nervous system lesions, cyanotic breath holding spells and neuromuscular disorders).[10]
- History of medications:
- Drugs causing methemoglobinemia[11] (eg, Dapsone, nitrates, nitroglycerin, local anesthetics, chloroquine, anilines and aniline dyes.)
- Drugs causing sulfhemoglobinemia (eg, sulfonamides, metoclopramide)[12]
- Amiodarone
- Beta blockers
- Silver
- Drug overdoasage/ drug abuse (eg, heroin)
- History of fever
- Fever may be present in infectious causes of cyanosis secondary to upper airway obstruction (eg, croup), lower airway disease (eg, pneumonia, empyema), and septic shock.
- Current or frequent exposure to cold[13][14]
- Miscellaneous:
- History of snake bites
- History of living in high altitudes[15]
- History of drowning and hanging
Common Symptoms
- The hallmark of cyanosis is bluish discoloration of the lips, tongue, buccal mucosa, gums, and sublingual tissues, as well as hands and feet.
- Cyanosis is present in association with a wide variety of cardiac, vascular, pulmonary, neurologic and neuromuscular disorders.
- Associated symptoms:[16][17]
- Chest pain: Cyanosis can be associated with pleuritic chest pain(eg, pulmonary embolism or pneumonia).
- Dyspnoea: Sudden onset of breathlessness can occur with pulmonary embolism, pulmonary edema, and asthma.
- Tachypnea
- Tachycardia
- Hypotension / Hypertension
- Somnolence
- Sweating
- Pallor
- Crying or fussiness
- Behavioural changes
For the detailed history and symptoms of diseases causing cyanosis click the links below
- Tetralogy of Fallot
- Tricuspid atresia
- Ebstein's anomaly
- Tricuspid stenosis
- Transposition of great arteries (TGA)
- Pulmonary stenosis
- Truncus arteriosus
- TAPVC
- Coarctation of aorta
- Aortic stenosis
- Eisenmenger's syndrome
- HLHS (Spectrum of hypoplastic left heart syndrome)
- Left-sided heart failure
- Acute chest syndrome
- Pneumothorax
- Foreign body aspiration
- Carbon monoxide poisoning
- Hydrogen cyanide poisoning
- Croup
- Bacterial tracheitis
- Hemothorax
- Pneumonia
- Asthma
- COPD
- Bronchiolitis
- Respiratory distress syndrome (Hyaline membrane disease)
- Empyema
- Pleural effusion
- Cystic fibrosis
- Atelectasis
- Bronchopulmonary dysplasia
- Alveolar capillary dysplasia
- Pulmonary embolism
- Pulmonary hypertension
- High Altitude
- Intracranial hemorrhage
- Seizures
- Choanal atresia
- Micrognathia or retrognathia
- Laryngomalacia
- Congenital diaphragmatic hernia
- Myasthenia gravis
- Apnea of prematurity
- Obstructive sleep apnea
- Pulmonary edema
- Pulmonary hemorrhage
- Pulmonary arteriovenous malformation
- Methemoglobinemia (congenital or acquired)
- Sulfhemoglobinemia
- Polycythemia vera
- Disseminated intravascular coagulation
- Shock
- Sepsis
- Amniotic fluid embolism
- Cold exposure
- Acrocyanosis
- Raynaud's phenomenon
- Raynaud's disease
- Peripheral vascular disease
- Buerger's disease
- Deep vein thrombosis
- Superior vena cava syndrome
References
- ↑ Waldman JD, Wernly JA (April 1999). "Cyanotic congenital heart disease with decreased pulmonary blood flow in children". Pediatr. Clin. North Am. 46 (2): 385–404. PMID 10218082.
- ↑ Grifka RG (April 1999). "Cyanotic congenital heart disease with increased pulmonary blood flow". Pediatr. Clin. North Am. 46 (2): 405–25. PMID 10218083.
- ↑ Just-Viera JO, Norwood T, Yeager GH (April 1967). "Importance of shock and cyanosis in pulmonary embolism". Ann. Surg. 165 (4): 528–35. PMC 1617449. PMID 6021453.
- ↑ Bellini C, Boccardo F, Campisi C, Bonioli E (October 2006). "Congenital pulmonary lymphangiectasia". Orphanet J Rare Dis. 1: 43. doi:10.1186/1750-1172-1-43. PMC 1637094. PMID 17074089.
- ↑ Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
- ↑ Chang YJ, Ali H, Draper A, Chua F (March 2013). "An unusual cause of cyanosis in a patient with COPD". BMJ Case Rep. 2013. doi:10.1136/bcr-2012-008092. PMC 3618735. PMID 23456158.
- ↑ Lee JY (June 2010). "Clinical presentations of critical cardiac defects in the newborn: Decision making and initial management". Korean J Pediatr. 53 (6): 669–79. doi:10.3345/kjp.2010.53.6.669. PMC 2994134. PMID 21189937.
- ↑ Hashim MJ, Guillet R (November 2002). "Common issues in the care of sick neonates". Am Fam Physician. 66 (9): 1685–92. PMID 12449267.
- ↑ Gozubuyuk AA, Dag H, Kacar A, Karakurt Y, Arica V (2017). "Epidemiology, pathophysiology, clinical evaluation, and treatment of carbon monoxide poisoning in child, infant, and fetus". North Clin Istanb. 4 (1): 100–107. doi:10.14744/nci.2017.49368. PMC 5530151. PMID 28752154.
- ↑ Patrinos ME, Martin RJ (August 2017). "Apnea in the term infant". Semin Fetal Neonatal Med. 22 (4): 240–244. doi:10.1016/j.siny.2017.04.003. PMID 28438477.
- ↑ Esbenshade AJ, Ho RH, Shintani A, Zhao Z, Smith LA, Friedman DL (August 2011). "Dapsone-induced methemoglobinemia: a dose-related occurrence?". Cancer. 117 (15): 3485–92. doi:10.1002/cncr.25904. PMC 3138875. PMID 21246536.
- ↑ Gopalachar AS, Bowie VL, Bharadwaj P (June 2005). "Phenazopyridine-induced sulfhemoglobinemia". Ann Pharmacother. 39 (6): 1128–30. doi:10.1345/aph.1E557. PMID 15886294.
- ↑ Nagpal BM, Sharma R (April 2004). "Cold Injuries : The Chill Within". Med J Armed Forces India. 60 (2): 165–71. doi:10.1016/S0377-1237(04)80111-4. PMC 4923033. PMID 27407612.
- ↑ Engelhart M, Seibold JR (June 1990). "Cyanosis and Raynaud's phenomenon: the relation to underlying disease and venous abnormalities". Angiology. 41 (6): 432–8. doi:10.1177/000331979004100603. PMID 2375536.
- ↑ Jensen JD, Vincent AL. PMID 28613569. Missing or empty
|title=(help) - ↑ Kothari SS (October 1992). "Mechanism of cyanotic spells in tetralogy of Fallot--the missing link?". Int. J. Cardiol. 37 (1): 1–5. PMID 1428277.
- ↑ Huh J, Kang IS, Lee HJ, Park SW (July 2010). "Clinical experience of chest pain in adults with congenital heart disease in a single tertiary center". Pediatr Cardiol. 31 (5): 620–5. doi:10.1007/s00246-010-9656-2. PMID 20143055.