Cyanosis of the nasolabial triangle in newborns. Mandatory medical intervention. Diagnosis and treatment of nasolabial cyanosis

Many people often experience the phenomenon of bluish skin. This pathological condition is called cyanosis. However, not everyone knows exactly what it is, how it is formed, what symptoms it manifests and how it is treated.

Description of the disease

Cyanosis of the skin and mucous membranes is a disease characterized by a bluish discoloration of the skin in certain areas of the body and limbs. Pathology can be diagnosed in both children and adults.

As a result of medical research, it was revealed that the development of the disease is due to increased content pathological hemoglobin, as a result of which the skin acquires blue tint. At the same time, experts note that blood saturation with oxygen does not occur in full.

Against this background, certain areas of the body do not receive enough blood, which is a provoking factor in the development of cyanosis.

In certain situations, the course of the disease is complicated by suffocation. If medical care is not provided in a timely manner, the risk of death increases.

Classification and locations

Based on the speed of development, the pathological process is divided into the following forms:

• spicy;
• subacute;
• chronic.

Based on the nature of its occurrence, the disease is classified into the following types:

• respiratory, which occurs as a result of circulatory disorders, as well as a lack of oxygen in the lungs;
• hematological, which develops with blood diseases;
• cardiac, which is also characterized by oxygen starvation and circulatory dysfunction;
• metabolic, it is provoked by improper absorption of oxygen by tissue cells;
• cerebral, the cause of which is the inability to combine oxygen with hemoglobin, which provokes ischemic disease brain cells.

When studying the nature of the distribution pathological condition Experts have identified the following varieties:

1. Diffuse cyanosis (central). The localization site is the entire surface of the body. The disease can be triggered by both a disruption of the respiratory system and improper general blood circulation.
2. Acrocyanosis. Blue skin tint is diagnosed only at the extreme points (lips, ears, tip of the nose). The reason for its development is venous stasis, chronic heart failure.
3. Peripheral. Among the provoking factors for the appearance of this type of pathology are disturbances in the functioning of the heart or arteries. In addition, ischemia of the face, legs or arms can contribute to the disease.
4. Local. Determined by examination of the genitals, pharynx or nasopharynx. Here we can talk about cyanosis of the vagina and cyanosis of the face.

In addition, there are such types of pathological conditions as:

• general, or total;
• isolated;
• perioral and distal;
• cyanosis of the extremities;
• transient and permanent.

In any case, in order to accurately determine the type of disease, you need to contact a specialist and undergo an examination.

Causes in adults

Among the most common factors are diseases of cardio-vascular system when tissues and organs do not receive required quantity oxygen. The process of impaired blood supply also provokes hypoxic damage to the skin.

The disease is usually accompanied by symptoms such as:

• pain in the chest area;
• rapid pulse;
• fast fatiguability;
• insomnia;
• headache;
• shortness of breath, etc.

Pathology appears as a result of the following diseases:

• pulmonary edema;
• ischemia and heart disease;
• varicose veins;
• thrombosis;
• thromboembolism pulmonary artery.

Other provoking reasons include:

• anemia, ;
• pleurisy;
• respiratory failure;
• bronchial asthma;
• pneumothorax;
• Quincke's edema;
• drug poisoning;
• epileptic and seizures;
• cholera;
• plague;
• tissue injury;
• prolonged presence in an unventilated area;
• hypothermia of the body.

As a rule, the peripheral form of cyanosis is diagnosed much more often than the central one.

Cyanosis in children

The development of a pathological condition in newborns can be caused by several provoking factors. These include:

• heart defects congenital type(central cyanosis, manifesting immediately after birth);
• aspiration asphyxia, stenotic croup, atelectasis and other lung diseases (respiratory form of the disease);
• cerebral edema, intracranial bleeding (cerebral cyanosis);
• methemoglobinemia (metabolic type, characterized by a concentration of potassium in the blood not exceeding 2 mmol/l).

Cyanosis of the nasolabial triangle in most cases occurs in infants, which is a sign of neuralgia, lung or heart disease.

In certain situations, cyanosis in an infant is considered normal. The cause of this condition is incompletely completed embryonic bleeding. The symptom disappears on its own within a couple of days.

Symptoms

The diffuse form is characterized by a blue tint to the skin of the perioral and periorbital areas. After this, it spreads to areas with thin skin. The severity of the peripheral form is observed in places far from the heart muscle. In most cases it is combined with swelling of the neck veins.

Depending on the nature of its occurrence, the disease is accompanied by multiple symptoms:

• general weakness;
• feverish condition;
• cough;
• tachycardia;
• dyspnea;
• other signs of intoxication.

For cyanosis, the development of which is caused by bronchopulmonary pathologies, in addition to the main symptoms, the following are characteristic:

• purple tint of mucous membranes and epidermis;
• sweating;
• moist cough;
• chest pain;
• hemoptysis.

At cardiovascular disorders signs such as:

• increased hematocrit;
• capillary stasis;
• secondary type erythrocytosis;
• deformation of fingernails.

When you first suspect the development of a pathological process, you must immediately seek medical help. Lack of proper treatment can cause various complications, including to whom.

Diagnostics

To put correct diagnosis and to identify the cause that provoked the development of cyanosis, the doctor first of all interviews the patient and collects anamnesis.

The specialist finds out when the first signs of cyanosis appeared and how often they appear, and identifies the circumstances that contributed to this condition. After this, the area of ​​localization of the pathology is determined and the change in shade throughout the day is specified..

• general analysis blood;
• determining the speed of blood fluid movement;
• study of cardiac and pulmonary performance;
• electrocardiography;
• capnography - the study of gases contained in exhaled air;
• analysis of the gas composition of arterial blood fluid;
• X-ray of the chest area;
• CT scan;
• catheterization of the heart muscle.

Only based on the results of all examinations performed, the doctor makes a diagnosis and prescribes the necessary therapy.

If difficulties arise in determining the type of disease, you need to take into account the fact that the disappearance of pulmonary cyanosis, in contrast to acrocyanosis, occurs a few minutes after the arrival of pure oxygen.

Features of treatment for children and adults

The main task of conducting therapeutic activities consists in eliminating the underlying disease, against the background of which cyanosis began to develop. To restore the amount of oxygen consumed by tissues, specialists prescribe medication and oxygen therapy.

Medication measures

Patients may be prescribed medications that help normalize blood flow, enhance erythropoiesis, and restore lung and heart function.

To reduce the symptoms of pathology, use medicines the following groups:

• neuroprotectors - Salmbutamol;
• anticoagulants - Warfarin;
• analeptics - Etimizole or Cititon;
• cardiac glycosides - Strophanthin;
• vitamin complexes.

At chronic form the patient is under illness dispensary observation attending physician. Constant monitoring of the process makes it possible to adjust therapy and prevent the development of complications.

Cyanosis is the blue discoloration of the skin different areas bodies. It should not be confused with redness when the baby cries, strains, coughs, or with spotty rashes of various types.

The child most often experiences cyanosis in the nasolabial triangle and under the eyes. This is due to thin skin, which allows changes in the capillary bed to pass through it. Mild cyanosis in children under one year of age is not considered a pathology. It is possible with a temporary imbalance in oxygen consumption.

Why does cyanosis occur in children?

The cause of the bluish tint of the skin is the accumulation of reduced hemoglobin in the blood instead of oxyhemoglobin. It changes the color of the blood because it is unable to bind and carry oxygen.

The resulting pathology is called hypoxia or oxygen starvation. Cyanosis is one of the clinical manifestations hypoxia.

The mechanism of education in children is no different from adults. There are child diseases that are rare and unusual for an adult body. They contribute different types hypoxia are accompanied by different clinical manifestations.

When does central cyanosis occur?

Central cyanosis (generalized, diffuse) is always associated with impaired cardiopulmonary circulation, depends on the compensatory capabilities of the heart structures and lung tissue(alveoli).

In newborns, this form of cyanosis occurs when:

• congenital defects heart, obstructing the blood supply to the lungs;
• acute lack of alveolar surfactant, blocking the complete expansion of the pulmonary lobules;
• aspiration of fluid into the bronchi, resulting asphyxia followed by atelectasis of the lung.

An infant is unable to cough up mucus from the nasopharynx. Any respiratory infection significantly complicate breathing. Lead to mechanical blockage of the upper respiratory tract.

The cartilage of the laryngeal rings is fully formed only by the age of three. Before this, the walls of the larynx are soft, inflammation quickly descends to the trachea and causes swelling and narrowing (stenotic croup). The baby is suffocating. This form of cyanosis is also called respiratory. It is always accompanied by pronounced cyanosis of the nasolabial triangle.

Blueness of the nasolabial triangle - serious symptom hypoxia

Pneumonia in a child tends to spread within a lobe. In this case, most of the lung tissue is excluded from breathing. Compensatory mechanisms in children are undeveloped, so oxygen starvation quickly sets in.

Bronchial asthma with frequent attacks suffocation worsens in adolescence. Mechanical narrowing of the bronchi causes a blue face.

Trauma to the skull that occurs during childbirth causes hemorrhage and cerebral edema and may be accompanied by diffuse cyanosis. It is called cerebral.

The picture of generalized cyanosis is typical for child poisoning with cleaning products and tablets.

When storing medications within reach of the curious little man parents are at great risk here

Child taking orally toxic substances, causes tissue hypoxia. It is characterized by a block of necessary tissue enzymes for the absorption of O2 by cells with a sufficient amount of hemoglobin and oxygen in the blood. A similar mechanism operates in teenage alcoholism and drug addiction.

The hemic form of hypoxia manifests itself as diffuse blue cyanosis with anemia in preschool children and adolescents, with intoxication infant on the nicotine concentration in the air when located in a fire area. Cyanosis of the nasolabial triangle indirectly indicates the central nature of the lesion.

One of the types of metabolic cyanosis can be considered to be associated with the presence of methemoglobin in the blood during tetanic convulsions of newborns. At the same time, the concentration of calcium decreases and phosphates increase.

Degrees of respiratory failure and cyanotic skin

IN respiratory failure There are 3 degrees. To determine them, the prevalence of cyanosis on the child’s skin is important:

• first degree - unstable cyanosis is observed in the perioral area, disappears after breathing an oxygen-air mixture consisting of 50% O2;
• second degree - in addition to the lips, cyanosis spreads to the hands and face; after inhaling the mixture, it does not disappear, but can be eliminated with the help of an oxygen tent;
• third degree - diffuse cyanosis, does not disappear with the help inhalation method treatment.

Peripheral cyanosis

The classic picture of peripheral cyanosis is observed with Raynaud's disease in adolescent girls. Narrowing, paroxysmal spasm of the arteries and capillaries of the hands causes a characteristic clinical picture: blueness, whiteness, and then redness of the fingers.

Acrocyanosis is considered a special type of peripheral symptoms - simultaneous blueness of the toes and hands, lips and perioral space, ears, and tip of the nose. This type is typical for a child with a heart defect:

• mitral stenosis;
• non-closure of the ductus botallus or interventricular foramen;
• tricuspid valve insufficiency;
• combined defect.

Circulatory hypoxia develops with impaired blood circulation, myocardial weakness, heart failure

In addition to acrocyanosis, the following are characteristic:

• cough,
• tachycardia,
• arrhythmias,
• swelling in the feet and legs (in case of decompensation).

How to diagnose the cause of cyanosis in a child?

If cyanosis is detected on the child’s body, the pediatrician prescribes:

• consultation with a cardiorheumatologist;
• Ultrasound of the heart and thymus;
• blood test for the content of red blood cells and hemoglobin, the presence unusual shapes hemoglobin;
• blood electrolytes;

If cyanosis is detected, all newborns are examined by a pediatric neurologist.

Features in the treatment of children with cyanosis

The basis of treatment is a targeted impact on the cause of the disease. By reducing cyanosis, the doctor judges the effectiveness of the therapy used.

To directly eliminate hypoxia, breathing with an oxygen-saturated air mixture is used, orally - oxygen cocktails. Perinatal centers and departments intensive care Children's hospitals are equipped with special oxygen tents and chambers. The child can move freely in them, he is not “tied” to the supply hoses of the device.

What should parents pay attention to?

Cyanosis in young children appears when there is freezing or an increase in body temperature. It goes away with warming and normalization of the condition. Such changes should be prevented by monitoring the child's clothing according to the weather and mobility.

Development sudden suffocation and cyanosis requires calling an ambulance. If before this there was a runny nose, hoarseness of voice, then we can assume false croup. Before the ambulance arrives, it is recommended to sit with the baby in the bathroom, creating high humidity there with the help of hot water. You can make foot or hand baths.

Home inhalers can be used with sufficient humidity

Asthma aids should be carried with you at all times.

If a heart defect is detected, you need to follow the recommendations of the cardiac surgeon for surgical treatment of the child.

To prevent anemia, children should be given fruit in the form of fresh fruits and berries, juices. In winter, drink compote and fruit juice. You should not practice vegetarianism or other diets on your child. It needs meat and milk for proper development.

Video about congenital heart defects - the most common reason cyanosis in children:

The appearance of a symptom such as cyanosis should alert parents. Timely diagnosis allows you to keep a healthy child.

Caring mothers always carefully examine their newborn baby. No less attention than weight loss, colic and diaper rash is attracted by the phenomenon of blue discoloration of the nasolabial triangle. cyanosis over upper lip, especially occurring when the child is at rest, can provoke real panic in the mother. It never hurts to see a doctor, because when you have a baby in the house, it’s better to be safe. Blue discoloration of the nasolabial triangle is not always a pathological phenomenon; it also occurs in absolutely healthy children first months of life.

Blueness of the nasolabial triangle in a baby causes many mothers to fear for the health of their baby

Medical name cyanosis of the nasolabial triangle - cyanosis. Its direct physiological source is insufficient oxygen concentration in the blood, which can occur in different situations, both non-hazardous and pathological. Let's figure out why cyanosis occurs and what its possible causes are. Negative consequences. The main thing that needs to be noted right away is that it can periodically happen to completely healthy babies, so go into a state of panic if you saw blue triangle above the baby’s upper lip, it’s not worth it.

What you need to know about the nasolabial triangle?

People call the place on a person’s face between the nasolabial folds, upper lip and nose the “triangle of death.” Despite such a dramatic name, the usual damage to the skin of the nasolabial triangle, blue discoloration, and the appearance of inflammatory elements in this place do not bring anything extremely tragic. It’s just that there are a lot of arterial and venous vessels, and these veins do not have valves, as a result of which infections and damage can enter the brain. Serious injuries to the nasolabial triangle are fraught with significant consequences.

Is there not enough oxygen in the blood? It is the skin of the nasolabial triangle that will begin to turn blue. Try to touch this area with your hands less often, avoid cuts and abrasions, and the occurrence of boils.

If skin damage occurs, treat the wound immediately antiseptic. Do not squeeze out a pimple or boil, but treat it quickly and effectively, otherwise the infection from the source of inflammation can penetrate through numerous vessels further down the face and into the brain. Does the boil take a long time to go away? Seek medical help, the surgeon will clean the canals and make drainage.

This article talks about typical ways to solve your issues, but each case is unique! If you want to find out from me how to solve your particular problem, ask your question. It's fast and free!

Blue discoloration of the nasolabial triangle occurs if the oxygen concentration in the blood drops below 95%. This happens in two cases:

• physiological reason;
• pathological reason.

The main physiological sources are the thinness of the skin on the face of a newborn and the incompetence of the infant’s respiratory system. TO pathological reasons include hypothermia, respiratory diseases, exposure to foreign body, disturbances in the functioning of the heart. Let's take a closer look at each of the cases.

Blueness of the nasolabial triangle in healthy children

Cyanosis is normal for babies in the first weeks of life. It is of pulmonary origin, occurs if a child bursts into tears, and is caused by imperfections in the respiratory system, which should go away over time.

If your baby continues to have cyanosis while crying after the second month of life, consult your doctor. It also happens that the cyanosis of the nasolabial triangle is associated with a structural feature skin. Too thin and bright skin as if glowing from within, of course, all the venous and arterial plexuses will be visible, due to which a blue tint appears. It is not uncommon for blue discoloration to appear during hypothermia, especially when swimming in too cool water. This should be a signal for parents to change the temperature of the bathing water to a warmer one that is more comfortable for the baby’s body.

Blue discoloration of the nasolabial triangle in pathological conditions

If cyanosis occurs due to illness, then the most common option is diseases of the cardiovascular system, according to Dr. Komarovsky, or the respiratory tract:

• heart disease;
• heart failure;
• a sharp decrease in blood pressure;
• pulmonary artery malformation;
• diseases of the nervous system;
• pneumonia;
• bronchitis;
• protracted viral disease manifested by runny nose, fever, high temperature bodies.

When is urgent medical advice needed?

What parents should be wary of:

1. The child has been suffering from a cold for a long time. He often experiences shortness of breath, wheezing, heavy breathing at night, and pronounced cyanosis has appeared. This may be a harbinger of pneumonia; urgent consultation with a pediatrician is needed.
2. Blueness of the perioral zone appears spontaneously, before this the baby’s chin begins to shake, arms and legs tremble, the child becomes anxious and cries. This may be a harbinger of heart disease; you need to consult a doctor.
3. There were small objects near the child, from buttons to toys. The baby's skin suddenly began to turn pale, breathing was interrupted, or wheezing, suffocation occurred, and cyanosis was pronounced. A foreign body has entered the respiratory tract, you must call an ambulance medical care. You can try to help the baby yourself - place the child on your knee upside down and gently pat him on the back. Compression chest may contribute to the expulsion of a foreign body from the respiratory tract.

Respiratory failure in a child

There are three degrees of respiratory failure:

• 1st degree - cyanosis is periodically observed in the area around the mouth, goes away after the patient breathes in an oxygen-air mixture, which includes 50 percent oxygen;
• 2nd degree - cyanosis is observed not only in the perioral zone, but also on the hands and on the entire face, eliminated only after exposure to an oxygen tent;
• Grade 3 – diffuse or generalized cyanosis (maximum degree of cyanosis), which cannot be eliminated by inhalation.

Diagnosis and treatment

If cyanosis does not occur naturally non-pathological reasons, then the baby will need not only a doctor’s consultation, but also diagnostics:

1. MRI of the brain. It is done for older children to exclude severe pathologies of the central nervous system.
2. . It is done to babies before the fontanelle closes, it allows to identify pathologies.
3. Cardiogram and ultrasound of the heart.
4. Chest X-ray. Allows you to eliminate the possibility of pneumonia, bronchitis, and foreign body entry.
5. Bronchoscopy. This thorough examination is done when a foreign body is suspected and the x-ray shows nothing.

Main symptoms:

• Blue discoloration of the nasolabial triangle
• Blue soles
• Blue ears
• Blue discoloration of the phalanges of the fingers
• Blueness of the skin
• Bluishness of the extremities
• Blueness of nails
• Blueness of mucous membranes

Cyanosis of the skin and mucous membranes is the appearance of an unnatural bluish tint in certain areas of the body and mucous membranes, which can occur in both a child and an adult. According to medical research, this pathological condition is caused by the fact that in the blood there is increased amount pathological hemoglobin, which makes its color similar to blue. In this case, there is insufficient oxygen saturation of the blood, as a result of which blood is not supplied to certain areas of the body in the required volume, which causes cyanosis of the skin and mucous membranes.

In some cases, this pathological condition is extremely difficult character, as it is accompanied by suffocation. And if a patient in such a condition is not provided with timely medical care, there is a high risk of death.

Varieties and reasons

The most common phenomenon is acrocyanosis, characterized by a change in the color of the skin on the distal parts of the body, that is, the limbs and face. Acrocyanosis predominantly develops in patients with cardiac pathology and may be evidence of development in a child or adult. In adults, acrocyanosis is also a sign of the development of some other pathologies. But the pathology also occurs in infants who do not have anomalies in the development of the cardiovascular system.

With this type of pathology, cyanosis is localized on the hands and feet, ears, tip of the nose and lips. For a baby in the first days of life, acrocyanosis is normal occurrence, since his lungs have not yet begun to function fully, which is manifested by an insufficient supply of oxygen to the blood. Acrocyanosis is more pronounced when the baby cries, makes excessive efforts during feeding, or is restless.

It is important to understand that there are different varieties of this pathological condition. So, in medical practice talk about central and local cyanosis. Central cyanosis develops in cases where the arterial blood is not sufficiently saturated with oxygen, which happens when serious illnesses, such as erythrocytosis, and others. This condition may indicate the need for urgent medical care for a person. This type is also called diffuse cyanosis, and it has the maximum severity.

With local cyanosis, impaired blood circulation is observed in a localized area due to local disruption of blood circulation. This form of pathology is observed in places of increased accumulation of blood vessels - around the mouth, around the eyes.

The local form is also called peripheral cyanosis. The causes of this form of the disease can be the following pathological conditions:

• slowing down of blood flow in the capillaries due to their compression by a tumor;
• poisoning of the body;
• heart and vascular diseases;
• and, preventing sufficient oxygen from entering the blood;
• breast deformation as a result traumatic injury with violation respiratory function.

Cyanosis of the nasolabial triangle is often diagnosed in infants, which indicates malformations of the lungs, heart and neuralgia.

In general, peripheral cyanosis occurs in medical practice more often than central cyanosis, since there are many more reasons that cause it.

Symptoms

If a patient has a form of pathology such as acrocyanosis, which is mainly found in infants, its symptoms will consist of blue discoloration of the nails, phalanges of the child’s fingers and soles, ears and nasolabial triangle, including mucous membranes. Blueness of the mucous membranes, nails and skin can be mild or severe - and the more pronounced it is, the more severe the child’s condition, which indicates acute respiratory failure.

Very often, cyanosis of the nasolabial triangle, as well as peripheral cyanosis, occurs in people with such pathological conditions as:

• convulsions;
• overdose narcotic drugs;
• food poisoning.

Symptoms of the pathological condition, manifested by blueness of the skin, nails and mucous membranes, differ depending on the type of disorder that caused acrocyanosis. Thus, in diseases of the lungs or bronchi, cyanosis of the lips, nasolabial triangle and mucous membranes is manifested by the dark purple color of this area, indicating a lack of oxygen.

In heart disease, acrocyanosis also occurs, but clinical picture complemented by other symptoms, such as:

• thickening of the phalanges of the fingers according to type drumsticks;
• wet rales;
• hemoptysis;
• dyspnea.

Cyanosis of the extremities occurs in the peripheral form of the pathology, and is diagnosed quite often in both adults and children. At the same time, cyanosis in newborns, as mentioned above, can be both pathological and physiological in nature, so medical care is required for infants only when the cyanosis is severe and does not go away for a long time.

Diagnostics

Acrocyanosis and other varieties of this pathological condition are not a disease in themselves. This is just a symptom of a serious pathology in the body of a child or adult, so when such a symptom appears important diagnostics takes place. First of all, if a child or adult has facial cyanosis, their respiratory system is checked, identifying the causes of the lack of oxygen in the blood. If a child is diagnosed with acrocyanosis, that is, blue discoloration of the limbs, mucous membranes, and nails, disorders in the functioning of the cardiovascular system are diagnosed first.

The main tests that are prescribed for patients with suspected acrocyanosis are:

• general blood test;
• blood gas analysis;
• blood flow velocity analysis;
• pulse oximetry.

Then, taking into account complaints and symptoms, as well as test data, research methods such as electrocardiography, chest CT, or chest x-ray may be prescribed.

Features of treatment

Acrocyanosis, as mentioned above, is a symptom of a pathological condition internal organs. Therefore, treatment in this case will be aimed at eliminating the underlying disease that caused the bluishness of the face, limbs, mucous membranes or nails.

One of the methods that is used to treat this pathological condition is oxygen therapy, in which the patient is given oxygen to inhale, thereby increasing its concentration in the blood. Treatment with oxygen therapy is used in conjunction with other measures to treat cardiac or respiratory failure that causes acrocyanosis.

Drug treatment is also used - drugs are prescribed that improve blood flow and increase the saturation of capillaries. Such drugs include:

• antihypoxants;
• bronchodilators;
• respiratory analeptics;
• cardiac glycosides and some other medications used as prescribed by a doctor.

Unfortunately, in most cases, treatment will be ineffective if acrocyanosis in a child or adult develops as a result of cardiac pathologies. In such situations, only effective surgical treatment, especially often used in infants born with heart abnormalities.

Is everything correct in the article? medical point vision?

Answer only if you have proven medical knowledge

Cyanosis is defined as a bluish discoloration of the mucous membranes and/or skin caused by high concentration reduced hemoglobin in the blood. Cyanosis caused by the ingress of various dyes into the blood or deposition in the skin various substances with such properties is called false cyanosis of the skin.

True cyanosis is considered a symptom of general and local hypoxemia. It is detected when the concentration of reduced hemoglobin in capillary blood is more than 50 g/l (with a standard of up to 30 g/l). It is pronounced in patients with polycythemia, while in anemia, cyanosis of the skin appears when more than half of the hemoglobin is reduced.

Causes of cyanosis

Cyanosis itself practically does not occur. It can develop as a result of acute, urgent illnesses and the patient’s conditions, and may be as a symptom of chronic, subacute conditions and diseases.

With the acute development of the disease, generalized cyanosis is usually observed. Pulmonary embolism is characterized by cyanosis of the upper half of the body, tachypnea and distress syndrome. With obstruction of the upper respiratory tract, the patient develops sudden cyanosis of the upper half of the body, cyanosis of the face and tongue.

Pulmonary edema is also characterized by cyanosis of the face, nasolabial triangle, and upper half of the body, which is accompanied by the release of pink foamy sputum and severe distress syndrome.

A patient with cyanosis of the skin, suffering from a subacute disease that developed within 3-5 days, most likely begins to develop pneumonia (pneumonia) or sepsis (blood poisoning). Also, generalized rashes along with cyanosis indicate toxic shock.

In patients who have chronic illness combined with cyanosis, most likely there are problems in the cardiovascular or pulmonary systems. There are signs of bronchitis with emphysema respiratory distress syndrome, whistling breathing and signs of difficulty exhaling, cyanosis of the facial skin. With interstitial fibrosis of the lungs, scattered wheezing and difficulty in chest excursion are observed. With pulmonary arteriovenous fistulas, patients may have: systolic murmur, cyanosis of the mucous membranes, hands.

With congenital heart defects, cyanosis is usually observed on the mucous membranes, nasolabial triangle, and fingernails and toenails. In addition, the patient has respiratory dysfunction, pathological form chest (protrusion of its left half), heart murmurs, a symptom of a cat purring. X-ray shows cardiomegaly, an altered silhouette of the heart. The ECG is changed and shows right ventricular hypertrophy.

Acutely occurring cyanosis (develops in a matter of seconds) can be observed with asphyxia (suffocation), thromboembolism of the pulmonary arteries, and cardiac tamponade. Cyanosis occurring over several hours may occur during a severe attack bronchial asthma, which does not stop, with lobar pneumonia lungs, in case of poisoning with methemo-lobin-forming agents. With the gradual, sometimes long development of cyanosis, we can confidently talk about problems of the heart and lungs.

Using the characteristics of cyanosis, a number of diseases can be diagnosed, which can in some cases save the patient’s life. Cyanosis can also be confused with a condition called carboxyhemoglobinemia, which occurs after inhaling carbon monoxide. Looks like red cyanosis.

According to their origin and their manifestations, they are distinguished: central cyanosis, or, as it is also called, diffuse cyanosis and peripheral cyanosis (acrocyanosis). Diffuse cyanosis is usually associated with an increased concentration of reduced hemoglobin in the arterial blood. This is observed in case of respiratory failure in patients with bronchopulmonary pathology, with thromboembolism of the pulmonary arteries, with hypertension of the pulmonary circulation; or when mixing venous and arterial blood with concomitant congenital and acquired defects of the cardiac septum or in the orifices between the aorta and the pulmonary trunk.

The severity of diffuse cyanosis varies from slightly bluish tint 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 in those areas of the body where there is thin skin (on the lips, tongue, under the nails and on the face).

IN in some cases Cyanosis can be caused by a decrease in atmospheric pressure (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 a decrease in arterial blood oxygen saturation may be observed.

Cyanosis of the nasolabial triangle in a child determines congenital heart disease. If such a sign appears for the first time and not in the very first months of the baby’s life, then you need to immediately contact a cardiologist or a pediatrician, or call an ambulance. This may indicate a heart or lung disease in the baby.

The diagnosis of heart disease is confirmed using an ECG and echo listening to the heart. Cyanosis of the nasolabial triangle is very often a sign of cerebral ischemia. This condition requires examination and recommendations from a neurologist. A final diagnosis can be made for the baby only with the help of ultrasound examination. The same signs may indicate diseases of the cardiopulmonary system in an adult. In this case, you need to perform a brain CT, MRI, EEG, REG. To exclude or confirm heart disease: consultation with 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 an adult. In this case, it is necessary to carry out clinical trial blood. Red cyanosis on the skin of the chin, cheekbones, eyebrows, and external genitalia can be observed in women with diabetes.

Cyanosis in a child

Cyanosis in a child at birth and in the first days of life can be of respiratory, cardiac, metabolic, cerebral and hematological origin. Localization along the periphery is characteristic of vasomotor cyanosis, which can usually be observed 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 colour. With diffuse cyanosis in Blue colour lips, mucous membranes, and skin are colored.

In a child, diffuse cyanosis, which manifests itself immediately or shortly after birth, is often caused by a congenital heart defect. Its intensity may depend on the size of the venoarterial shunt, on the blood volume flowing through the lungs, and on the hemoglobin content in the arterial blood.

Respiratory diffuse cyanosis can be observed with pulmonary atelectasis, aspiration asphyxia, hyaline membrane disease, pneumonia and other bronchopulmonary diseases.

In the first degree of respiratory failure, cyanosis is observed in the perioral region. It is unstable, intensifying with nervous tension and disappears upon inhalation of 50% oxygen.

In the second degree, cyanosis is also perioral, but can also be on the skin of the face and hands. It is permanent, does not disappear when you inhale 50% oxygen, but it is absent in the oxygen tent.

In the third degree of respiratory failure, generalized cyanosis is observed, which does not go away with inhalation of 100% oxygen. Cyanosis in children with intracranial hemorrhage and cerebral edema is called cerebral cyanosis. Metabolic cyanosis can occur with tetany in newborns, when the calcium level in the blood plasma is less than 2 mmol/l and hyperphosphatemia occurs.

photo of cyanosis under Wood's lamp

Cyanosis of the skin

Cyanosis of the skin can be located in any area. Cyanosis of the extremities can be caused by venous stasis or arterial thromboembolism. Peripheral acrocyanosis may be a specific benign condition in which cyanosis is more pronounced on upper limbs than on the lower ones. And it is associated with different densities of the capillary bed.

Cyanosis of the skin, more pronounced on the arms than on the legs, may indicate transposition of the large arteries with the presence of excessive coarctation. At the same time, the emerging pulmonary hypertension reduces the degree of release through the patent ductus arteriosus, 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 hand, while the right hand has a relatively normal skin color, confirm the diagnosis of pulmonary hypertension with reverse flow of arterial blood through open duct arterial, due to which unoxygenated arterial blood enters the lower extremities.

When the pulmonary artery is damaged, black cyanosis develops; with diseases of the cardiac muscle, the cyanosis is darker than with respiratory dysfunction; with thrombosis of the main veins, cyanosis of the extremities occurs with their swelling; with marbled or spotty cyanosis of the extremities, we can talk about thrombosis or embolism of the main vessels, or Marburg's symptom; acrocyanosis in the area of ​​the forearms and hands may indicate Cassirer's angioneurosis in young women; dark purple spots in the area of ​​the nose, ears, fingers develop due to microthrombosis; red cyanosis of the face occurs with polycythemia, with tumors of internal organs; bright red cyanosis of the face occurs with tumors of the adrenal glands and pituitary gland; saffron-colored cyanosis on the skin of the soles and hands is observed with hemorrhages in the abdominal cavity; cyanosis of the face and torso with a purple tint can be observed in acute; facial cyanosis and pinpoint hemorrhages in the face and neck area they speak of asphyxia of a traumatic nature; spotty cyanosis on lower limbs indicates chronic venous insufficiency; cyanosis of the feet can occur during prolonged cooling in high humidity or during hypothermia; Cyanosis of the feet and hands may occur in the first stage.

Cyanosis treatment

Treatment of cyanosis is determined by the underlying disease. Often, mainly in emergency cases, the presence of cyanosis alone is an indication for oxygen therapy, thereby leading to intensification of treatment of the underlying disease. In these cases, a decrease or elimination of cyanosis can be regarded as an indicator of the effect of the treatment. In case of cyanosis that occurs acutely, it is necessary to immediately call an ambulance team.

Acrocyanosis appears to be a benign condition, and if a specialist makes such a diagnosis, then there is no need for therapeutic measures.

Methemoglobinemia in half of the cases can be congenital, and in the other half of cases it can occur due to taking medications. It is often caused by aniline derivatives, nitrites, and sulfonamides. Methemoglobinemia due to medications disappears quickly after discontinuation medicinal product. Oral administration of Methylene Blue at a dose of 150-200 mg per day restores the oxygen transport function of arterial blood in two types of methemoglobinemia, while Ascorbic Acid in a dose of 150 to 550 mg can have an effect only in congenital methemoglobinemia.

In a condition of acute obstruction of the respiratory tract, which has developed as a result of ingestion and stuckness of food, cricothyrotomy may be the method of choice for therapy. In the event that obstruction upper paths respiratory is caused by inflammation or swelling of the epiglottis, a tracheotomy is required.

When treating pulmonary thromboembolism, therapy with Streptokinase and Heparin is required. As a rule, pulmonary embolism, which is accompanied by cyanosis, requires urgent artificial ventilation and oxygen therapy.

For pneumonia and sepsis, which lead to cyanosis, the following may be indicated: artificial ventilation, oxygen and antibiotics wide range actions.

For pneumothorax that results in cyanosis, drainage may be performed. pleural cavity and artificial ventilation.

Treatment for pulmonary edema largely depends on the cause of the disease. Cardiogenic pulmonary edema is typically defined by an excessive increase in pulmonary capillary pressure and is treated with diuretics and drugs that reduce the subsequent workload on the heart. Non-cardiogenic pulmonary edema is often associated with impaired capillary permeability in the alveoli, although capillary pulmonary pressure may remain normal. The main method of therapy in this category of patients is artificial ventilation.

Therapy for emphysema involves the use of bronchodilators, with artificial ventilation lungs, and in the treatment of concomitant bacterial infection. In exceptional patients with allergic airway damage, corticosteroid drugs are prescribed.

Therapy for congenital heart defects involves determining accurate diagnosis, controlling pulmonary infection if present, preventing endocarditis infectious nature and in the treatment of polycythemia. Polycythemia can be very dangerous in male adolescents during puberty; hematocrit values ​​greater than 70% are generally poorly tolerated and erythropheresis is required to reduce symptoms and reduce the risk of thromboembolic complications. Moreover, there may be complications such as thrombosis, gout and hypertension.