Cyanosis of the nail bed

Introduction Purpura refers to the phenomenon of diffuse bruising on the skin and mucous membranes. Generally, it is most obvious in areas where the skin is thin, the pigment is small, and the blood is sufficient, such as a nail bed, and other lips, tongue, oral mucosa, nose, cheeks, and earlobe. Plateau heart disease can be characterized by clubbing, lips, nail bed cyanosis, mainly due to chronic hypoxia caused by impaired right heart function. Most of them occur in the plains who migrated to the plateau or from moderate to higher altitudes, and their incidence increased with altitude.

Cause

The cause of cyanosis in the clinic (due to the increased amount of reduced hemoglobin in the blood) is very high. The color of the purplish skin can be temporarily regressed after exerting pressure (the abnormal color pigmentation of the skin is unchanged). In cold environments, due to vasoconstriction of the skin, hair can also appear in healthy people. Plateau heart disease occurs mostly in the plains who migrate to the plateau or from moderate to higher altitudes, and their incidence increases with altitude. In addition to the differences in hypoxia, this disease is often a predisposing factor for fatigue, cold, and respiratory infections.

an examination

Related inspection

Blood oxygen saturation

Clinical manifestations:

Mainly for pulmonary hypertension, right ventricular hypertrophy and right heart failure. Children have irritability, sleepless nights, difficulty breathing, cyanosis, pulmonary artery second tone, liver enlargement, lower extremity edema. Adults have heart palpitations, fatigue, weakness, coughing, difficulty breathing, pulmonary artery second tone hyperactivity or division, severe cases of liver enlargement, lower extremity edema, oliguria and so on.

Laboratory inspection:

X-ray, electrocardiogram, echocardiography, etc. showed signs of significant pulmonary hypertension and right ventricular hypertrophy. Right heart catheterization, mean pulmonary artery pressure >25mmHg. Exclude other cardiovascular diseases, especially pulmonary heart disease. When the condition is changed to plain or low altitude, the condition is relieved, the pulmonary artery pressure drops, and the heart function returns to normal.

Differential diagnosis

High altitude heart disease is easily confused with the following diseases:

1. Congenital heart disease: The prevalence of congenital heart disease, especially patent ductus arteriosus in the highland area is very high, and it is easy to be confused with pediatric hypertensive disease. However, the systolic murmur of the patent ductus arteriosus is rough and conduction, and X-ray examination has many The lung door dance.

2, pulmonary heart disease: pulmonary heart disease and high heart disease in some aspects are very similar, there are certain difficulties in identification. However, the former has a history of chronic cough, the pulmonary ventilation function is significantly abnormal, and the latter's lung function is basically normal.

3, primary pulmonary hypertension: the disease is rare, the disease progresses progressively, and the disease is not relieved from the plateau environment.

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