Cyanosis is defined as the bluish color of the mucous membranes or / and skin, due to the high concentration of hemoglobin in the blood restored. Cyanosis, caused by the ingress of various dyes or deposition in the skin of various substances with such properties, called false cyanosis of the skin.
True cyanosis is considered a symptom of general and local hypoxemia. It is detected at a concentration of reduced hemoglobin in capillary blood of more than 50 g / l (with a standard up to 30 g / l). It is pronounced in patients with polycythemia, whereas in cases of anemia, cyanosis of the skin appears when more than half of the hemoglobin is recovered.
Cyanosis itself is almost not found. It can develop due to acute, urgent illnesses and conditions of the patient, and maybe as a symptom of chronic, subacute conditions and diseases.
In acute development of the disease, as a rule, generalized cyanosis is observed. In embolism of the pulmonary artery, cast iron cyanosis of the upper half of the trunk, tachypnea and distress syndrome are characteristic. With obstruction of the upper respiratory tract, the patient develops a sudden cyanosis of the upper half of the trunk, cyanosis of the face and tongue.
Lung edema is also characterized by cyanosis of the face, nasolabial triangle, upper half of the trunk, which is accompanied by the release of pink foamy sputum and pronounced distress syndrome.
In a patient with cyanosis of the skin, suffering from a subacute disease that developed within 3-5 days, the development of pneumonia (pneumonia) or sepsis (blood infection) is likely to begin. Also, generalized rashes along with cyanosis suggest a toxic shock.
Patients with a chronic disease associated with cyanosis are likely to have problems in the cardiovascular or pulmonary systems. With bronchitis with emphysema, there are signs of respiratory distress syndrome, wheezing and signs of labored exhalation, cyanosis of the facial skin. With interstitial lung fibrosis, scattered wheezing and difficulty in chest excursion are observed. When pulmonary arteriovenous fistulas in patients can be: systolic murmur, cyanosis of the mucous membranes, hands.
With congenital heart defects, cyanosis, as a rule, is observed on the mucous membranes, nasolabial triangle, on the nails of the hands and feet. In addition, the patient has a violation of the function of breathing, the pathological form of the chest (protrusion of its left half), noises in the heart, a purring symptom of a cat. The radiograph shows cardiomegaly, a modified silhouette of the heart. The ECG is changed and shows the right ventricular hypertrophy.
Acutely emerging cyanosis (developing in a matter of seconds) can be observed with asphyxiation (choking), thromboembolism of pulmonary arteries, cardiac tamponade. Cyanosis that occurs within a few hours, can be with a severe attack of bronchial asthma, which does not stop, with croupous pneumonia of the lungs, when poisoning with methaemolabine-forming agents. With the gradual, sometimes long development of cyanosis, it is safe to talk about heart and lung problems.
With the help of cyanosis, a number of diseases can be diagnosed, which can in some cases save a patient's life. Cyanosis can also be confused with a disease such as carboxyhemoglobinaemia, which occurs after inhaling carbon monoxide. It has the form of red cyanosis.
In its origin and its manifestations distinguish: central cyanosis, or, as it is called, diffuse cyanosis and peripheral cyanosis (acrocyanosis). Diffuse cyanosis, as a rule, is associated with an increased concentration of reduced hemoglobin in the blood of the arterial. This is observed with respiratory failure in patients with bronchopulmonary pathology, with thromboembolism of pulmonary arteries, with hypertension of the small circulation; or when mixing venous and arterial blood with accompanying congenital and acquired defects of the heart walls or in the estuarine between the aorta and the pulmonary trunk.
The severity of diffuse cyanosis changes from a slightly bluish shade of the tongue and lips with an ashy shade of the skin to a dark bluish-violet, sometimes brown color of the entire skin of the body. It is more noticeable on the mucous membranes and on those parts of the body where there is a thin skin (on the lips, tongue, under the fingernails and on the face).
In some cases, a decrease in pressure in the atmosphere can lead to cyanosis (for example, flying in an airplane or climbing).
Cyanosis of the nasolabial triangle
Cyanosis of the nasolabial triangle is also called periorbital cyanosis, that is, cyanosis around the eyes. It is considered the first sign of central cyanosis, which is characteristic of diseases of the pulmonary system, in which the saturation of arterial blood with oxygen can be observed.
Cyanosis of the nasolabial triangle in a child determines congenital heart disease. If this sign first appeared and is not in the very first months of the baby's life, you should immediately contact a cardiologist or a pediatrician, or call an ambulance. This may indicate a heart or lung disease in the baby.
Diagnosis of heart disease is confirmed by ECG and echoes of the heart. Cyanosis of the nasolabial triangle is very often a sign of cerebral ischemia. This condition requires examination and recommendations of a neurologist. Final diagnosis of the baby can only be done with the help of ultrasound. The same signs can also indicate the diseases of the cardiopulmonary system in an adult. In this case it is necessary to carry out CT of the brain, MRI, EEG, REG. For elimination or confirmation of heart disease: consultation of a cardiologist, ECG, ultrasound of the heart, X-ray.
Since cyanosis of the nasolabial triangle indicates a lack of oxygen (hypoxia), you can think about the presence of anemia in a child or an adult. In this case, it is necessary to conduct a clinical blood test. Cyanosis of a red shade on the skin of the chin, cheekbones, superciliary arches, and external organs of the genital can be observed in women with diabetes mellitus.
Cyanosis in the child
Cyanosis in a child at birth and in the first days of life can be by origin respiratory, cardiac, metabolic, cerebral and hematological nature. Localization along the periphery is characteristic of vasomotor cyanosis, which can be observed usually in the first weeks of a baby's life, much less often - in the first months. Cyanosis is present on the hands, feet, and the mucous membranes and lips remain pink. With diffuse cyanosis in blue, the lips, mucous membranes, and skin are also colored.
In a child, diffuse cyanosis, which manifests itself immediately or in the near future after birth, is often due to congenital heart disease. Its intensity may depend on the size of the venoarterial shunt, the blood volume flowing through the lungs, and the hemoglobin content in the arterial blood.
Respiratory diffuse cyanosis can occur with lung atelectasis, asphyxia of aspiration, hyaline-membrane disease, pneumonia and other bronchopulmonary diseases.
At the first degree of insufficiency, respiratory cyanosis is observed in the perioral region. It is unstable, aggravated by nervous tension and disappears when inhaled with 50% oxygen.
At the second degree, cyanosis is also perioral, but still can be on the face skin, on the hands. It is permanent, does not disappear when inhaled with 50% oxygen, but it is absent in the oxygen tent.
At the third degree of respiratory failure, generalized cyanosis is observed, which does not pass through the inhalation of 100% oxygen. Cyanosis in children with intracranial hemorrhage and with edema of the brain is called cerebral cyanosis. Metabolic cyanosis can occur in tetany in newborns, when calcium content in the blood plasma is less than 2 mmol / l and there is hyperphosphataemia.
Cyanosis of the skin
Cyanosis of the skin can be located on any part of it. Cyanosis of the extremities can cause venous congestion or thromboembolism of the artery. Peripheral acrocyanosis can be a special benign condition in which cyanosis is more pronounced in the upper limbs than in the lower extremities. And it is associated with a different density of the capillary bed.
Cyanosis of the skin, more pronounced on the hands than on the legs, may indicate a transposition of the arteries of large with the presence of excessive coarctation. In this case, the emerging pulmonary hypertension reduces the degree of ejection through the uninfected arterial duct, which causes oxygenated blood to flow to the extremities. Fingers, in the form of drumsticks and cyanosis, which is more pronounced on the legs than on the left arm, while the right arm has a relatively normal color of the skin, confirm the diagnosis of pulmonary hypertension with the reverse flow of arterial blood through the open duct arterial, for which the lower extremities receive non-oxygenated arterial blood.
With the defeat of the pulmonary artery, black cyanosis develops; with diseases of the muscle, cardiac cyanosis is more dark than with violation of respiratory function; with thrombosis of the veins of the main arises cyanosis of the extremities with their edema; with marble, or spotted cyanosis of limbs, it can be about thrombosis or embolism of the vessels of the main, or the symptom of Marburg; acrocyanosis in the area of the forearms and hands can speak in young women about Cassirer's angioneurosis; dark crimson spots in the region of the nose, ears, fingers develop with microthrombosis; red cyanosis of the face occurs with polycemia, with tumors of internal organs; bright red cyanosis of the face is present with tumors of the adrenal glands and pituitary gland; cyanosis of saffron color on the skin of the soles and brushes is observed with hemorrhages in the abdominal cavity; Cyanosis of the face and trunk with a purple hue can be observed in acute pancreatitis ; cyanosis of the face and pinpoint hemorrhages in the face and neck indicate asphyxia of traumatic character; spotted cyanosis on the lower extremities testifies to chronic venous insufficiency; cyanosis of the feet can occur with prolonged cooling in high humidity or under supercooling; cyanosis of the feet and brushes may be at the first stage of Raynaud's syndrome .
Treatment of cyanosis is determined by the main disease. Often, mainly in urgent cases, the presence of only cyanosis is an indication for oxygen therapy, thereby leading to an intensification of treatment of the underlying disease. In these cases, the reduction or elimination of cyanosis can be regarded as an indicator of the effect of the treatment. With cyanosis, which has arisen sharply, it is necessary to immediately call an ambulance team.
Acrocyanosis is presented in the form of a benign condition, and if the expert makes such a diagnosis, then there is no need for therapeutic measures.
Methemoglobinemia in half the cases may be congenital, and may in the other half of cases arise due to the use of medications. Often, it is caused by aniline derivatives, nitrites, sulfonamides. Methemoglobinemia due to drugs quickly disappears after drug withdrawal. Oral administration of blue methylene in a dose of 150-200 mg per day restores the oxygen transport function of arterial blood in two types of methemoglobinemia, at this time, ascorbic acid in a dose of 150 to 550 mg can give effect only in congenital methemoglobinemia.
In the state of acute obstruction of the airways, which has developed as a result of ingestion and stuck food, cryptothyroidism may be the method of choice of therapy. In the event that the obstruction of the upper respiratory tracts is caused by inflammation or a tumor of the epiglottis, a tracheotomy is required.
When therapy for pulmonary thromboembolism, therapy with streptokinase and heparin is required. As a rule, with pulmonary embolism, accompanied by cyanosis, urgent ventilation of the lungs and oxygen therapy are needed.
For pneumonia and sepsis, which lead to the emergence of cyanosis, can be shown: artificial ventilation, oxygen and the reception of broad-spectrum antibiotics.
With pneumothorax, which leads to the appearance of cyanosis, drainage of the pleural cavity and artificial ventilation of the lungs can be performed.
Therapy of pulmonary edema largely depends on the cause of the disease. Cardiogenic pulmonary edema is usually determined by an excessive increase in pulmonary pressure in the capillaries and is cured with diuretics and drugs that reduce the subsequent burden on the heart. Not cardiogenic pulmonary edema is often associated with impaired capillary permeability in the alveoli, capillary pulmonary pressure may remain normal. The main method of therapy in this category of patients is artificial ventilation.
Therapy of emphysema and bronchitis consists of the use of bronchodilators, with artificial ventilation of the lungs, and in the treatment of concomitant bacterial infection. Exclusive patients with allergic injuries of the respiratory tract are prescribed corticosteroid drugs.
Therapy for congenital heart diseases consists in determining the exact diagnosis, controlling pulmonary infection, if any, in preventing endocarditis of infectious nature and in the therapy of polycythaemia. Very dangerous is polycythemia in adolescent males at the time of their puberty; hematocrit values exceeding 70% are generally poorly tolerated by patients, and eryferesis is required to reduce symptoms and reduce the risk of thromboembolic complications. Moreover, there may be complications such as migraine headaches , thromboses, gout and hypertension.