Cyanosis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

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.

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.

• 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:
      • hypoplastic left heart syndrome
      • aortic stenosis
      • Coarctation of the aorta
    • 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
• 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

• 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

• 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

[[Category:Primary Care]