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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.

Images

Heart - section through the middle
Cardiac catheterization
Heart - front view
Tetralogy of Fallot
Clubbing
Cyanotic heart disease

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Causes

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

Heart defects that children are born with can change the way blood flows through the heart and lungs. These defects can cause less blood to flow to the lungs. They can also result in blue and red blood mixing together. This causes poorly oxygenated blood to be pumped out to the body. As a result:

Some of these heart defects involve the heart valves. These defects force blue blood to mix with red blood through abnormal heart channels. 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:

Other heart defects may include abnormalities in valve development or in the location and connections between blood vessels. Some examples include:

Certain medical conditions in the mother can increase the risk of certain cyanotic heart diseases in the infant. Some examples include:

Symptoms

Some heart defects cause major problems right after birth.

The main symptom is cyanosis 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:

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:

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:

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:

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. Some surgeries may be staged as the child grows. 

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 provider 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 provider.

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

Outlook (Prognosis)

The outlook depends on the specific disorder and its severity.

Possible Complications

Complications of cyanotic heart disease include:

When to Contact a Medical Professional

Call your provider if your baby has:

Prevention

Women who are pregnant should get good prenatal care.

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 provider about screening for genetic diseases.

Related Information

Blue discoloration of the skin
Tetralogy of Fallot
Transposition of the great arteries
Tricuspid atresia
Total anomalous pulmonary venous return
Truncus arteriosus
Trisomy 13
Turner syndrome
Marfan syndrome
Noonan syndrome
Ellis-van Creveld syndrome
Rubella
Alcohol use and safe drinking
Acne

References

Bernstein D. Cyanotic congenital heart disease: evaluation of the critically ill neonate with cyanosis and respiratory distress. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, MBBS, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2019:chap 456.

Lange RA, Hillis LD. Congenital heart disease. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier; 2018:106-111.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease in the adult and pediatric patient. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 75.

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Review Date: 10/22/2019  

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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