This document discusses cyanosis, defined as a bluish discoloration of the skin and mucous membranes due to low oxygen saturation in the blood. It describes two main types of cyanosis - peripheral and central cyanosis. Peripheral cyanosis is caused by low oxygen saturation at the venous end of capillaries and affects the extremities. Central cyanosis involves decreased oxygen saturation in arterial blood and affects more central areas. Causes, signs, and treatments are provided for each type. Investigations like pulse oximetry, blood gases, and hyperoxia testing are also summarized to differentiate between cardiac and pulmonary causes of cyanosis.

1. APPROACH TO CYANOSIS
Sarath tk
116 batch

2. DEFINITION
• Cyanosis is derived from the word ‘CYAN’,which comes from ‘Kyanous’,the greek
word for blue.
• Cyanosis is the bluish discolouration of the skin and mucous membrane due
to the presence of increased amount of reduced
haemoglobin/deoxyhaemoglobin (>5g/dl)or of haemoglobin derivatives
(sulphhaemoglobin and methaemoglobin) in the capillary blood.
• Cyanosis is normally detected when the oxygen saturation is (SaO2) is <85%

3. TYPES
1.Peripheral cyanosis
2.Central cyanosis

4. PERIPHERAL CYANOSIS
• Arterial blood is normally saturated but there is oxygen unsaturation
at the venous end of capillary. may be due to sluggish peripheral
circulation
• Excessive extraction of oxygen by the peripheral tissues from the
arterial blood .

5. • SITES- Tip of nose
Ear lobules
Outer aspect of lips,cheeks and chin
• Tips of fingers and toes.
• Nail bed of fingers and toes.
• Palms and soles.
• Tongue remains unaffected

6. CAUSES
• Exposure to cold air or cold water (vasoconstriction)
• Reduced cardiac output(Congestive cardiac failure)
• Shock or peripheral circulatory failure
• Hyperviscosity syndromes(Polycythemia, Multiple myeloma)
• Mitral stenosis( Lips, tip of nose and cheeks cyanosed in mitral
facies)
• Venous obstruction (SVC syndrome)-local cyanosis
• Arterial sclerosis ( Atherosclerosis)

7. CENTRAL CYANOSIS
• Pathological condition caused by decreased arterial oxygen
saturation either due to defective oxygenation in lungs or
admixture of venous and arterial blood.
• Usually detected when the oxygen saturation of arterial
blood goes below 80 - 85%.
• it involves highly vascularized tissues through which blood
flow is at brisk.
• Cardiac output is normal and patients have warm extremities.

8. SITES
• Tongue(margins and
undersurface)
• Inner aspect of lips
• Mucous membrane of gums ,soft
palate, cheeks.
• Lower palpebral conjunctiva.
• Also the sites mentioned in
peripheral cyanosis ( both can
occur together)

9. CAUSES
• Cyanotic congenital heart diseases eg: Tetralogy of fallot
,transposition of great aorta,Total anomalous pulmonary venous
return,Truncus arteriosus,Tricuspid atresia.
• Eisenmenger’s syndrome(ASD,VSD,PDA with reversal of shunt)
• Single ventricle.
• Acute pulmonary edema ( due to left sided heart failure)-most
common cause.
• Lobar pneumonia
• Asthma

10. • COPD ,cor pulmonale
• Congenital diaphragmatic hernia.
• Birth asphyxias.
• Seizures.
• ICH
OTHERS-Polycythemia,methaemoglobinemia,metabolic
disease,infections(sepsis)

12. DIFFERENTIAL CYANOSIS
• Hands red (less blue)and feet blue seen in PDA with
reversal of shunt
• I t requires pulmonary vascular resistance elevated to
a systemic level and a patent ductus arteriosus.
• Desaturated blood from the ductus enters the aorta
distal to subclavian artery,sparing the brachiocephalic
circulation.

13. MIXED CYANOSIS
• Central and peripheral cyanosis present in a single
patient.
• Seen in -Acute MI with acute LVF
CCF due to left sided heart failure
Rarely in polycythemia

14. ENTEROGENOUS OR PIGMENT CYANOSIS
• Cyanosis due to excessive
sulphaemoglogin(>0.5g/dl)or methaemoglobin
(>1.5g/dl)in blood.
• Causes are hereditary haemoglobin M
disease,poisoning by aniline dyes ,drugs like nitrates
and nitrites(nitroglycerin,sodium nitroprusside
etc),carboxyhaemoglobinaemia (a cherry red flush in
smokers)

15. DIFFERENTIAL DIAGNOSIS OF BLUISH
DISCOLOURATION OF BODY
• Cyanosis
• Carbon monoxide poisoning.
• Argyria -silver poisoning-does not blanch on pressure
• osteogenesis imperefcta-sclera is blue due to thinness
• Drugs like amiodarone -ceruloderma

16. MANAGEMENT
• AIM:
To differentiate physiological and pathological
cyanosis
To differentiate cardiac from non cardiac causes.
Find causes which needs urgent referral or treatment.

17. • Do: Complete maternal and newborn history
Perform a full physical examination.
Investigations

27. INVESTIGATION
• PULSE OXIMETRY
• Standard methord pf monitoring infants with rds cyanosis
• Normal >=95%
• Mesurements usually not performed when child is crying or moving as it
reduces the quality of signal

28. ARTERIAL BLOOD GAS
• Arterial PO2: to confirm central cyanosis :SaO2 not as good
an indicator dueto Increase fetal Hb affinity for O2 (left-shift)
• Increase PaCO2: may indicate pulmonary or CNS disorders,
heart failure
• Decrease pH: sepsis, circulatory shock, severe hypoxemia
• Methemoglobinemia: Decrease SaO2, normal PaO2,
chocolate-brown blood

29. HYPEROXIA TEST
• Hyperoxia test is the initial method to distinguish CCHD from pulmonary
disease.
• The test consists in measuring an arterial blood gas at room air and 100%
inspired oxygen after 10 minutes.
• Neonates with congenital heart disease are usually not able to increase PaO2
above 100 mm Hg during 100% oxygen administration
• . In patients with pulmonary disease, PaO2 generally increased greater than or
equal to 100 mm Hg with 100% oxygen as ventilation-perfusion discrepancies
are overcome.
• A positive result indicates the cardiac origin and further cardiac workup is
indicated to rule out CCHD

30. BLOOD INVESTIGATIONS
• INCREASE OR DECREASE WBS INDICATES SEPSIS
• HAEMATOCRIT>65%:POLYCYTHEMIA

31. • FURTHER X RAY AND ECG HELPS CONFIRM CARDIAC OR PULMONARY
CAUSE

32. TREATMENT
• Warming of the affected area - in peripheral cyanosis
• Oxygenation and adequate ventilation.
(Partial press of oxygen normalises completely during artificial ventilation
in infant with CNS disorder)
.IV fluids- children with feeding difficulty
. If sepsis is suspected or another specific cause is not identified ,start on
broad spectrum antibiotics and then obtain a full septic screening.

33. .Drugs- Prostaglandin E1
For ductal dependant CHD- iv infusion of PGE1 to maintain patency 0.1mcg/kg/min.
. Surgery

34. THANK YOU