3 year old has blue finger/toenails

I hope I'm asking this question in the right place.  I have a 3 yr old boy with asthma and allergies so I posted on the asthma board first.  However, the response indicated that what is happening w/my son is not likely to be related to his asthma and may be cardiac in nature.  He has had episodes off and on since he was about 2 1/2 where his toenails/fingernails turn blue.  Initially it was thought it may be due to sleep apnea as they only occured after sleep and cleared after 15-30 min of awakening.  He did in fact have apnea and had T&A in Nov/07.  Following surgery he could not keep sats up (78% w/o O2 and 90% w/50% O2--took 4L via canula to get to 98%) and had a HR of 170.  They finally came down to HR 150 and O2 up to 96% on room air the next a.m. and w left hospital.  At home he would have more severe episodes where his whole hand or lower half of his face would turn blue when he cried.  This lasted a few weeks and then stopped for about 6 weeks but have started again.  It does not seem to be related to circulation/coldness and he doesn't usually have breathing problems at the same time.  He did have an echo which initially showed a "possible extra vessel" (don't know more specifics) but a second echo ruled this out.  The second echo was supposed to be done w/saline contrast but was not, even still the cardiologist said there was no extra vessel and said cyanosis was not due to heart defect.  The surgeon & anesthesiologist both thought he may be having shunting--would an echo rule this out completely?  Can you have shunting anywhere else in the body or just the heart?  Are there other tests you would recommend?
Thank you in advance for considering my question, Elaine

[Douglas Bogart, MD]

It sounds like a shunt to me and clearly you should have your son seen by a pediatric cardiologist.

[ireneo]

This may not be the case at all but something to consider is Raynauds. It will cause color changes in feet and hands, sometimes nose and ears. There are a couple of simple tests for it. Maybe check with a rheumatologist.  I'm happy to hear the echo showed no heart defect.

[elaine1972]

Thanks for the thought! It doesn't seem to be related to temperature and it also doesn't affect his fingers/hands (except the period right after surgery) just the nail beds and his lips/lower face sometimes.  Can young children have Raynauds?  I'm willing to entertain any thoughts but I'm thinking more along the lines of cardiac or his asthma right now.

[ireneo]

Yes, there are cases of very young children being diagnosed with Raynauds. I visit a Raynauds msg board and have learned so much from them. I also have it. Raynauds is not only triggered by cold temps (anything under 60 degrees). It can be caused by stress or body position. My feet are gray/blue any time I sit or stand without moving around. My fingers puff and turn colors when I'm at the computer for more than 30 minutes.

I also have asthma, even had some bad episodes where my peak flow dropped below 250. But it never affected my color.

I certainly don't want to add to your list of worries. Your son has enough going on in his life without adding to it. It was just a thought. And Raynauds can be primary (just by itself) or secondary to something else like lupus, scleroderma, rheumatoid arthritis, etc. That's why I thought a rheumatologist might be able to help. There's a simple blood test that can be done to check ANA and a nail bed test to check the capillaries. Neither one is very invasive. I do hope you get answers soon. Take care.

[elaine1972]

Thanks for the info, I certainly did not know that a 3 yr old could have Raynauds or that it could be triggered by stress or body position.  I will ask his pediatrician what his thoughts are and go from there!  Thanks again and I hope that all is currently well with your asthma and the Raynauds.