Cyanosis

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What is cyanosis?

Cyanosis is a bluish hue to the skin, gums, fingernails, or mucous membranes caused by a lack of oxygen in the blood. When blood is fully oxygenated it appears bright red; when it lacks oxygen supply, the blood is a dark purple or bluish red. This lack of oxygen in the blood supply to a body part, such as the nail bed, skin, or mucous membrane, causes that body part to take on a bluish tint.

Oxygen is present in your blood through hemoglobin, a red blood cell protein that carries oxygen. As red blood cells travel through the lungs, hemoglobin picks up oxygen, carries it out to the cells and tissues in the rest of your body, and releases it, at which point the blood becomes cyanotic. Then the blood carrying these red blood cells circulates back again to the lungs for more oxygen. Cyanosis occurs either when there is insufficient fresh oxygen getting to the bloodstream or when sluggish blood can’t reoxygenate quick enough.

Cyanosis can be caused by abnormal hemoglobin or an overall lack of oxygen. An overall lack of oxygen may occur due to through trauma (like choking or suffocation) or chronic disorders that compromise heart or lung function, such as cyanotic heart disease. Abnormal hemoglobin may, for example, take the form of a disorder called methemoglobinemia.

Cyanosis can be a symptom of a serious disorder. Seek immediate medical care (call 911) if you have bluish coloration of the lips or fingernails and experience difficulty breathing, shortness of breath, chest pain, or confusion or loss of consciousness even for a brief moment. Also seek immediate medical care (call 911) if you are with a child who has bluish skin and is having difficulty breathing, chest muscles pulling in with every breath; rapid breathing; grunting; sitting very still with shoulders hunched; limpness or lethargy; flaring nostrils with breathing; irritability, fussiness, poor feeding, and poor sleeping.

If you notice unusual changes in skin color, or if you have been treated for a disorder related to your cyanosis, but the cyanosis itself is persistent or causes you concern, seek prompt medical care.

What other symptoms might occur with cyanosis?

Cyanosis may accompany other symptoms that vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the circulatory system may also involve other body systems.

Cardiac and respiratory symptoms that may occur along with cyanosis

Cyanosis may accompany other symptoms affecting the heart or respiratory system including:

  • Chest pain
  • Difficulty breathing
  • Leaning forward when sitting to breathe more easily
  • Rapid breathing (tachypnea) or shortness of breath
  • Use of rib cage muscles in an attempt to breathe more easily
  • Squatting (young children)

Other symptoms that may occur along with cyanosis

Cyanosis may accompany symptoms related to other body systems including:

  • Confusion or loss of consciousness for even a brief moment
  • Enlargement of the skin beneath the nail beds (clubbing)
  • Fever
  • Irritability, fussiness, poor feeding, and poor sleeping in infants and young children
  • Lethargy
  • More frequent headaches than you typically have

Serious symptoms that might indicate a life-threatening condition

In some cases, cyanosis may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bluish coloration of the skin, fingernails, or mucous membranes
  • Chest pain
  • Confusion or loss of consciousness for even a brief moment
  • Difficulty breathing
  • Lethargy
  • Limpness or lethargy

What causes cyanosis?

Cyanosis can be caused by abnormal hemoglobin or an overall lack of oxygen. An overall lack of oxygen occurs through trauma, such as choking or suffocation, or such disorders, as cyanotic heart disease.

Cardiovascular causes of cyanosis

Cyanosis may be caused by cardiovascular disorders including:

  • Blood clot that blocks blood supply

  • Congenital heart defects

  • Methemoglobinemia (overproduction of an abnormal hemoglobin)

  • Other blood disorders that produce abnormal hemoglobin

  • Raynaud’s phenomenon (spasms of small blood vessels of the fingers and toes, reducing blood circulation; Raynaud’s phenomenon is secondary to many autoimmune disorders such as lupus)

Respiratory causes of cyanosis

Cyanosis can also be caused by respiratory disorders including:

Other causes of cyanosis

Cyanosis can also be caused by other events or disorders including:

  • Drug overdose

  • Exposure to cold

  • High altitude (decreased oxygen levels)

  • Seizures of long duration

  • Underwater diving accidents (barotrauma)

Serious or life-threatening causes of cyanosis

In some cases, cyanosis may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Cardiopulmonary arrest

  • Cardiovascular disease such as congestive heart failure (deterioration of the heart’s ability to pump blood)

  • Choking

  • Drug overdose

  • Epiglottitis (life-threatening inflammation and swelling of the epiglottis, a tissue flap between the tongue and windpipe)

  • Near-drowning incident

  • Pulmonary embolism (blockage of an artery in the lungs due to a blood clot)

Questions for diagnosing the cause of cyanosis

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your cyanosis including:

  • How long have you had this bluish discoloration? What parts of your body are bluish?

  • Are you having difficulty breathing?

  • Do you find it easier to breathe in a specific position?

  • How rapidly did these symptoms come on?

  • Have you inhaled anything?

  • Have you had any swelling, especially in your feet or legs?

  • Do you have chest pain?

  • Do you have any other symptoms?

  • What medications are you taking?

What are the potential complications of cyanosis?

Because cyanosis can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 8
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Skin discoloration - bluish. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm
  2. Cyanotic heart disease. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001104.htm
  3. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.