Locations Main Campus: Chesterfield, MO 63017   |   Locations
314-434-1500 314-434-1500   |   Contact Us

Multimedia Encyclopedia

BACK
TO
TOP
 
E-mail Form
Email Results

 
 
Print-Friendly
Bookmarks
bookmarks-menu

Cyanotic heart disease

Right-to-left cardiac shunt; Right-to-left circulatory shunt

 

Cyanotic heart disease refers to a group of many different heart defects that are present at birth (congenital). They result in a low blood oxygen level. Cyanosis refers to a bluish color of the skin and mucous membranes.

Causes

 

Normally, blood returns from the body and flows through the heart and lungs.

  • Blood that is low in oxygen (blue blood) returns from the body to the right side of the heart.
  • The right side of the heart then pumps the blood to the lungs, where it picks up more oxygen and becomes red.
  • The oxygen-rich blood returns from the lungs to the left side of the heart. From there, it is pumped to the rest of the body.

Heart defects that children are born with can change the way blood flows through the heart and lungs. This causes non-oxygenated blood to be pumped out to the body without going through the lungs to pick up oxygen. As a result:

  • The blood that is pumped out to the body is lower in oxygen.
  • Less oxygen delivered to the body can make the skin look blue ( cyanosis ).

Many of these heart defects involve the heart valves. Heart valves are found between the heart and the large blood vessels that bring blood to and from the heart. These valves open up enough for blood to flow through. Then they close, keeping blood from flowing backward.

Heart valve defects that can cause cyanosis include:

  • Tricuspid valve (the valve between the 2 chambers on the right side of the heart) may be absent or unable to open wide enough.
  • Pulmonary valve (the valve between the heart and the lungs) may be absent or unable to open wide enough .
  • Aortic valve (the valve between the heart and the blood vessel to the rest of the body) is unable to open wide enough.

Other heart defects that may cause cyanosis include:

  • Coarctation or complete interruption of the aorta
  • Ebstein anomaly
  • Hypoplastic left heart syndrome
  • Tetralogy of Fallot
  • Total anomalous pulmonary venous return
  • Transposition of the great arteries
  • Truncus arteriosus

Cyanotic heart diseases may be caused by:

  • Chemical exposure
  • Genetic and chromosomal syndromes, such as Down syndrome , trisomy 13 , Turner syndrome , Marfan syndrome , and Noonan syndrome
  • Infections (such as rubella ) during pregnancy
  • Poorly controlled blood sugar level in women who have diabetes during pregnancy
  • Medicines prescribed by your doctor or bought on your own and used during pregnancy
  • Street drugs used during pregnancy

 

Symptoms

 

Some heart defects cause major problems right after birth.

The main symptom is cyanosis. This is a bluish color of the lips, fingers, and toes that is caused by the low oxygen content in the blood. It may occur while the child is resting or only when the child is active.

Some children have breathing problems (dyspnea). They may get into a squatting position after physical activity to relieve breathlessness.

Others have spells, in which their bodies are suddenly starved of oxygen. During these spells, symptoms may include:

  • Anxiety
  • Breathing too quickly (hyperventilation)
  • Sudden increase in bluish color to the skin

Infants may get tired or sweat while feeding and may not gain as much weight as they should.

Fainting (syncope) and chest pain may occur.

Other symptoms depend on the type of cyanotic heart disease, and may include:

  • Feeding problems or reduced appetite, leading to poor growth
  • Grayish skin
  • Puffy eyes or face
  • Tiredness all the time

 

Exams and Tests

 

Physical examination confirms cyanosis. Older children may have clubbed fingers.

The doctor will listen to the heart and lungs with a stethoscope. Abnormal heart sounds, a heart murmur, and lung crackles may be heard.

Tests will vary depending on the cause, but may include:

  • Chest x-ray
  • Checking oxygen level in the blood using an  arterial blood gas test or by checking it through the skin with a pulse oximeter
  • Complete blood count (CBC)
  • ECG (electrocardiogram)
  • Looking at the heart structure and blood vessels using echocardiogram or MRI of the heart
  • Passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin ( cardiac catheterization )
  • Transcutaneous oxygen monitor (pulse oximeter)
  • Echo-Doppler
  • Testing the heart's electrical system

 

Treatment

 

Some infants may need to stay in the hospital after birth so they can receive oxygen or be put on a breathing machine. They may receive medicines to:

  • Get rid of extra fluids
  • Help the heart pump harder
  • Keep certain blood vessels open
  • Treat abnormal heartbeats or rhythms

The treatment of choice for most congenital heart diseases is surgery to repair the defect . There are many types of surgery, depending on the kind of birth defect. Surgery may be needed soon after birth, or it may be delayed for months or even years.

Your child may need to take water pills (diuretics) and other heart medicines before or after surgery. Be sure to follow the correct dosage. Regular follow-up with the doctor is important.

Many children who have had heart surgery must take antibiotics before, and sometimes after having any dental work or other medical procedures. Make sure you have clear instructions from your child's heart doctor.

Ask your child's doctor before getting any immunizations. Most children can follow the recommended guidelines for childhood vaccinations.

 

Outlook (Prognosis)

 

The outlook depends on the specific disorder.

 

Possible Complications

 

Complications of cyanotic heart disease include:

  • Abnormal heart rhythms and sudden death
  • Chronic high blood pressure in the blood vessels of the lung
  • Heart failure
  • Infection in the heart
  • Stroke

 

When to Contact a Medical Professional

 

Call your health care provider if your baby has:

  • Bluish skin (cyanosis) or grayish skin
  • Breathing difficulty
  • Chest pain or other pain
  • Dizziness, fainting, or heart palpitations
  • Feeding problems or reduced appetite
  • Fever, nausea, or vomiting
  • Puffy eyes or face
  • Tiredness all the time

 

Prevention

 

Women who are pregnant should get good prenatal care.

  • Avoid using alcohol and drugs during pregnancy.
  • Tell your doctor that you are pregnant before taking any prescribed medicines.
  • Get a blood test early in the pregnancy to see if you are immune to rubella. If you are not immune, you must avoid any exposure to rubella and should get immunized right after delivery.
  • Pregnant women with diabetes should try to get good control over their blood sugar level.

Some inherited factors may play a role in congenital heart disease. Many family members may be affected. If you are planning to get pregnant, talk to your doctor about screening for genetic diseases.

 

 

Open References

References

Bernstein D. Cyanotic congenital heart disease. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds.  Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 429.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.

 
  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Cardiac catheterization

    Cardiac catheterization - illustration

    Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants.

    Cardiac catheterization

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

  • Tetralogy of Fallot

    Tetralogy of Fallot - illustration

    Tetralogy of Fallot is a birth defect of the heart consisting of four abnormalities that results in insufficiently oxygenated blood pumped to the body. It is classified as a cyanotic heart defect because the condition leads to cyanosis, a bluish-purple coloration to the skin, and shortness of breath due to low oxygen levels in the blood. Surgery to repair the defects in the heart is usually performed between 3 and 5 years old. In more severe forms, surgery may be indicated earlier. In most cases the heart can be surgically corrected and the outcome is good.

    Tetralogy of Fallot

    illustration

  • Clubbing

    Clubbing - illustration

    Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.

    Clubbing

    illustration

  • Cyanotic heart disease

    Cyanotic heart disease - illustration

    Cyanotic heart disease is a congenital heart defect which results in low oxygen levels in the blood and causes the child's lips, fingers, and toes to look blue (cyanosis).

    Cyanotic heart disease

    illustration

    • Heart, section through the middle

      Heart, section through the middle - illustration

      The interior of the heart is composed of valves, chambers, and associated vessels.

      Heart, section through the middle

      illustration

    • Cardiac catheterization

      Cardiac catheterization - illustration

      Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants.

      Cardiac catheterization

      illustration

    • Heart, front view

      Heart, front view - illustration

      The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

      Heart, front view

      illustration

    • Tetralogy of Fallot

      Tetralogy of Fallot - illustration

      Tetralogy of Fallot is a birth defect of the heart consisting of four abnormalities that results in insufficiently oxygenated blood pumped to the body. It is classified as a cyanotic heart defect because the condition leads to cyanosis, a bluish-purple coloration to the skin, and shortness of breath due to low oxygen levels in the blood. Surgery to repair the defects in the heart is usually performed between 3 and 5 years old. In more severe forms, surgery may be indicated earlier. In most cases the heart can be surgically corrected and the outcome is good.

      Tetralogy of Fallot

      illustration

    • Clubbing

      Clubbing - illustration

      Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.

      Clubbing

      illustration

    • Cyanotic heart disease

      Cyanotic heart disease - illustration

      Cyanotic heart disease is a congenital heart defect which results in low oxygen levels in the blood and causes the child's lips, fingers, and toes to look blue (cyanosis).

      Cyanotic heart disease

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Cyanotic heart disease

           
             

            Review Date: 10/22/2015

            Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

             
             
             

             

             

            A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.



            Content is best viewed in IE9 or above, Firefox and Google Chrome browser.