Images of Memorable Cases: Case 133 This 18-year-old, healthy-appearing, asymptomatic woman had cyanotic nailbeds. 133. Congenital cyanotic heart disease Digital clubbing with cyanotic nail beds in an otherwise healthy-appearing, asymptomatic young adult is characteristic of a congenital cardiac anomaly with right-to-left shunting. The patient shown had tetralogy of Fallot, the most common congenital cyanotic heart disease in adults.