Cyanosis causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]; Ogheneochuko Ajari, MB.BS, MS [3]
Overview
Cyanosis occur because of lack of oxygen in the blood and often due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs (central cyanosis) or due to inadequate circulation to the extremities (peripheral cyanosis). Cyanosis is commonly caused by respiratory disorders and it is also seen in a wide variety of cardiac and vascular disorders and the management depends on the causative factor.
Causes
Cyanosis can be caused by the following mechanisms, systemic arterial oxygen desaturation and increased oxygen extraction by the tissues. Based on these mechanisms, cyanosis can be either central or peripheral. Certain conditions present with bluish purple discoloration of skin or mucous membranes can mimic cyanosis, are not associated with hypoxemia or peripheral vasoconstriction and is called Pseudocyanosis.
Common causes:
Central cyanosis:
There following are some of the common causes of central cyanosis:
- Pulmonary causes:
- Conditions associated with decreased concentration of inspired oxygen (FiO2):[1]
- Smoke inhalation most commonly from house fires
- Carbon monoxide poisoning
- Hydrogen cyanide poisoning
- Intentional or unintensional exposure to asphyxiating gases (eg, Propane, methane, butane, hydrogen sulphide)
- Impairment of chest wall or lung expansion:
- External compression
- Pneumothorax[2]
- Hemothorax
- Flail chest
- Hypoventilation:
- Upper airway obstruction: [3][4][5]
- Foreign body aspiration
- Pertussis / Croup
- Epiglottitis
- Bacterial tracheitis
- Birth asphyxia
- Traumatic disruption (Thermal injury, fractures)
- Congenital airway abnormalities:
- Choanal atresia
- Laryngotracheomalacia
- Macroglossia
- Micrognathia or retrognathia (eg, Pierre-Robin syndrome)
- Upper airway obstruction: [3][4][5]
- Ventilation/perfusion mismatch:[6]
- Asthma
- Pulmonary embolism
- Atelectasis
- Alveolar capillary dysplasia
- emphysema or COPD
- Pulmonary edema
- Pulmonary hypoplasia
- Pulmonary hemorrhage
- Respiratory distress syndrome (Hyaline membrane disease)
- Transient tachypnea of the newborn
- Conditions causing impaired oxygen diffusion:
- Intrinsic lung diseases:
- Conditions associated with decreased concentration of inspired oxygen (FiO2):[1]
- Vascular causes:
- Cardiac tamponade
- Cyanotic congenital heart diseases (Right to left shunts):
- Decreased pulmonary flow:
- Tetralogy of fallot
- Tricuspid valve anomalies:
- Pulmonary stenosis (critical valvular)
- Pulmonary atresia with intact ventricular septum
- Increased pulmonary flow:
- TGA (Transposition of great arteries, most common dextro type)
- Truncus arteriosus
- TAPVC (Total anamalous pulmonary venous connection)
- Heart failure: Condition that present with cyanosis and severe heart failure include:
- Left sided obstructive lesion (HLHS)
- Coarctation of aorta
- Critical valvular aortic stenosis
- Decreased pulmonary flow:
- Eisenmenger syndrome
- congestive heart failure
- Atrial septal defect
- Pulmonary hypertension
- Pulmonary edema
- Pulmonary hemorrhage
- Pulmonary embolism
- pulmonary arteriovenous malformation
- Multiple small intrapulmonary shunts
- Shock
- Sepsis
- Amniotic fluid embolism
- Hematologic abnormalities:
- Methemoglobinemia (congenital or acquired)
- Sulfhemoglobinemia (acquired)
- Hemoglobin mutations with low oxygen affinity: Hb Kansas, Hb Beth israel, Hb Saint Mande, Hb Bruxells
- Polycythemia vera
- Disseminated intravascular coagulation
- Neurologic abnormalities:
- CNS depression
- Birth asphyxia
- Severe head trauma
- Apnea of prematurity
- Obstructive sleep apnea
- Infections (eg, meningitis, encephalitis)
- Intraventricular hemorrhage
- Seizures
- Cyanotic breath holding spells
- Coma
- Neuromuscular disorders:
- Myasthenia gravis
- Injury to the phrenic nerve
- Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
- Metabolic disorders:
- Severe hypoglycemia
- In born errors of metabolism
- Hematologic abnormalities:
- Methemoglobinemia (congenital or acquired)
- Sulfhemoglobinemia (acquired)
- Hemoglobin mutations with low oxygen affinity: Hb Kansas, Hb Beth israel, Hb Saint Mande, Hb Bruxells
- Polycythemia vera
- Disseminated intravascular coagulation
- Miscellaneous:
- Drugs and chemicals:
- Beta blockers
- Nitrite or nitrate-containing compounds (eg, nitroglycerin)
- Dapsone
- sulfonamides
- Benzocaine
- chloroquine
- Heroin
- snakebites
- Acute chest syndrome
- Brief resolved unexplained events (BRUE)
- High altitude
- congenital diaphragmatic hernia
- cirrhosis of liver
- Drowning
- Chocking
- Hanging
- Hypothermia
- Drugs and chemicals:
Peripheral Cyanosis:
There following are some of the Common causes of Peripheral Cyanosis: [7] [8]
- Various conditions that cause central cyanosis can also cause peripheral cyanosis.
- Cold exposure
- Decreased cardiac output
- Acrocyanosis
- Erythrocyanosis
- Raynaud's phenomenon
- Raynaud's disease
- Arterial obstruction (Peripheral vascular disease, Buergers disease)
- Venous obstruction (Thromboembolism, Deep vein thrombosis, Superior vena cava syndrome
- Redistribution of blood flow from extremities
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Carbon monoxide poisoning
- Cardiac tamponade
- Cyanide poisoning
- Disseminated intravascular coagulation
- Epiglottitis
- Ethylene glycol
- Foreign body aspiration
- Hemothorax
- Malathion
- Myocardial infarction
- Parathion
- Pulmonary embolism
- Tension pneumothorax
Causes by Organ System
Causes in Alphabetical Order
Causes of Cyanosis Based on Classification
Causes of Central Cyanosis
Causes of Peripheral Cyanosis
- Acrocyanosis
- Asthma
- Beta blockers
- Buergers disease
- Chronic obstructive pulmonary disease
- Cold exposure
- Congenital heart disease
- Deep vein thrombosis
- Emphysema
- Erythrocyanosis
- Heart failure
- High altitude
- Hypothermia
- Hypovolemia
- Methemoglobinemia
- Peripheral arterial disease
- Polycythemia vera
- Pulmonary embolism
- Raynaud's disease
- Raynaud's disease
- Raynaud's phenomenon
- Sepsis
- Shock
- Tetralogy of Fallot
References
- ↑ Dueñas-Laita A, Burillo Putze G, Alonso JR, Bajo A, Climent B, Corral E, Felices F, Ferrer A, Hernández Frutos MP, Nogué S, Puiguriguer J (December 2010). "[Basis for the clinical management of fire smoke poisoning "Docohumo Madrid 2010"]". Med Intensiva (in Spanish; Castilian). 34 (9): 609–19. doi:10.1016/j.medin.2010.07.007. PMID 21051109.
- ↑ Costumbrado J, Ghassemzadeh S. PMID 29083723. Missing or empty
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(help) - ↑ Gossman WG, Burns B. PMID 29261942. Missing or empty
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(help) - ↑ Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
- ↑ Watanabe M, Takagi S, Magara J, Mano H, Tsunoda M, Nakadaira H, Endoh K, Yamamoto M, Kato K, Akai S (April 1991). "Cytogenetic analysis of human bile for mutagenicity and co-mutagenicity". Tohoku J. Exp. Med. 163 (4): 255–61. PMID 1715615.
- ↑ Maitre B, Similowski T, Derenne JP (September 1995). "Physical examination of the adult patient with respiratory diseases: inspection and palpation". Eur. Respir. J. 8 (9): 1584–93. PMID 8575588.
- ↑ Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH (2016). "Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms". Front Pharmacol. 7: 438. doi:10.3389/fphar.2016.00438. PMC 5110514. PMID 27899893.
- ↑ Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.