This is one of the symptoms of heart and vessel or respiratory problems. Cyanosis manifests itself as a bluish or bluish-gray discoloration of the skin and mucous membranes.
The cause of the discoloration of the skin and mucous membranes is too high level of poorly oxygenated hemoglobin (over 5g / 100 ml – in capillary blood). But the bluish discoloration of the body’s integuments may also depend on an accumulation in the skin of, for example, silver or hemosiderin, proteins that contain iron in colloidal form. Homosiderin deposits form when there is excess iron in the body.
Cyanosis that is not related to the level of hemoglobin deoxygenation is called pseudo cyanosis. Cyanosis, which is related to hemoglobin, is divided into central, peripheral and mixed.
Central cyanosis is caused by a decrease in oxygenated hemoglobin in the pulmonary capillaries. This occurs as a result of heart leak defects with right-to-left shunt or as a result of lung disease.
The most common cardiological causes of central cyanosis include defects in the atrial and interventricular septum, patent ductus arteriosus due to permanent pulmonary hypertension, and the tetralogy of Fallot. The latter disease is a complex heart defect, which consists of four elements: a narrowing of the pulmonary artery, a defect in the interventricular septum, a shift of the aorta to the right (the aorta is located above the right and left ventricles simultaneously), and right ventricular hypertrophy. It is the most common heart disease characterized by cyanosis.
The tetralogy of Fallot manifests itself in the first months of life through the bruising of the labia, mucous membranes and the peripheral parts of the limbs. Thickening of the phalanges appears, and the nail plates bulge, resembling watch glass.
Regardless of the cause, central cyanosis is most visible in places with good blood supply, such as the mucosa of the oral cavity, nose or conjunctiva, lips and nail bed. Central cyanosis appears more often when there is too much hemoglobin in the blood.
Peripheral cyanosis occurs due to the deoxygenation of hemoglobin in the capillaries due to the slow flow of blood. It occurs in acute form as cardiogenic shock, as well as in chronic, i.e. advanced heart failure. Cyanosis is very visible on the limbs, ear lobes, red lips, nose and cheeks. It is usually accompanied by a grayish tinge of the skin and cooling of the distal parts of the body, such as the nose or ears.
Mixed cyanosis occurs due to the mechanisms outlined above, e.g. heart failure in the course of congenital leakage disease.
Even if there is no clear bruising of the mucous membranes, cyanosis may be evidenced by constant cold and damp hands. This form of the disease manifests itself in the fact that the skin is a bluish-purple tinge, it is cool and constantly sweating. Skin color changes initially appear around the wrists (sometimes at the ankles) and gradually spread towards the toes, which usually appear normal. Cooling down or freezing the skin significantly intensifies the changes and may cause them to spread over the entire hand or foot. On the other hand, heating the hands or feet makes the unsightly blue-red spots disappear. It is also important that there are no ulcerations or atrophic changes on the skin. Autogenous cyanosis of the limbs usually affects girls and young women.
Treatment consists of the administration of vasodilators, such as those given in the treatment of Raynaud’s disease, a spasmodic spasm of the arteries in the hands (less commonly the feet) caused by cold, emotions, or for no apparent reason.
Text: Anna Jarosz
Also read: Congenital heart defects in children