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Goljan says that cyanosis occurs particularly in right heart failure because there is increased time for peripheral tissues to extract oxygen which leads to a decreased oxygen saturation. Isn't that a paradox? I mean even if there is increased extraction of oxygen in the tissues and saturation in the venous system goes down, won't gas exchange in the lungs equilibrate it back to alveolar oxygen levels? I don't understand what I'm missing there. Can someone please explain? Its in page 164 in the 3rd edition of Rapid Review Pathology.