Abstract: Solid evidence shows that obstructive sleep apnea (OSA) is independently associated with cardiovascular risk. Airway obstruction during sleep predispose to cardiopulmonary disorders such as systemic hypertension, coronary artery disease and stroke, representing a negative impact on public health. Also, OSA has been associated with the development of endothelial dysfunction, arrhythmias, heart failure and pulmonary hypertension (PH). These associations have promoted the development of evidence that allows to understand the independent impact of this syndrome. This review of the literature published in MEDLINE, which is the most important database of the National Library of Medicine, aims to show the role that OSA has as cardiovascular risk and focus on its association with the development of pulmonary hypertension for being a predisposing factor for ventricular dysfunction.

Resumen: Existe evidencia sólida de que el síndrome de apnea obstructiva del sueño (SAOS) es un factor de riesgo cardiovascular. Los eventos de obstrucción de la vía aérea durante el sueño predisponen a alteraciones como hipertensión arterial sistémica, cardiopatía isquémica y enfermedad vascular cerebral, representando éstas un impacto negativo en la salud pública de nuestro medio. El SAOS se asocia, además, con disfunción endotelial, arritmias, insuficiencia cardíaca e hipertensión pulmonar (HP). Estas asociaciones han generado el desarrollo constante de evidencia que permite comprender el impacto independiente de este síndrome. En esta revisión de la literatura publicada en MEDLINE que es la base de datos más importante de la National Library of Medicine, tiene como objetivo mostrar al SAOS como un factor de riesgo cardiovascular, con especial atención a su asociación con el desarrollo de HP por ser un factor predisponente de disfunción ventricular.

Pulmonary embolism is a common cause of death. Massive pulmonary thromboembolism requires an aggressive and timely therapeutic approach. Acute pulmonary embolism associated with hemodynamic instability (shock or hypotension) has a high risk of mortality in the early hours (25-65%) and 10% risk of progressing to cardiogenic shock; an estimate of up to 50% of cases are associated with recurrent pulmonary thromboembolism. The treatment based on evidence that has shown clinical improvement and decreased risk of mortality is anticoagulation. However, there are clinical conditions in which the use of this therapy may be contraindicated or can be detrimental to the patient's clinical status and therefore other therapeutic options should be considered. At present there is no concrete evidence based on clinical trials for the use of alternative options for the treatment of pulmonary embolism that are comparable with anticoagulation. We will discuss the different options available in acute pulmonary embolism.

La tromboembolia pulmonar es una enfermedad común y una de las principales causas de muerte. El tromboembolismo pulmonar masivo requiere un abordaje e intervención terapéutica agresivos y oportunos. La tromboembolia pulmonar aguda asociada a inestabilidad hemodinámica (choque o hipotensión arterial) tiene un riesgo alto de mortalidad (25-65%) en las primeras horas, y hasta el 10% de riesgo de progresar a choque cardiogénico; se estima que hasta en el 50% de los casos esta se asocia a tromboembolia pulmonar recurrente. El tratamiento que con base en la evidencia ha demostrado mejoría clínica y disminución en el riesgo de mortalidad es la anticoagulación. Sin embargo, existen condiciones clínicas en las que el inicio de esta terapia puede estar contraindicado; es decir, deberán considerarse otras opciones terapéuticas. Al presente, no existe evidencia concreta en base a estudios clínicos, de la utilidad de las opciones alternas que sean comparables con la anticoagulación, en el tratamiento de la tromboembolia pulmonar; se discuten las distintas opciones disponibles en tromboembolia pulmonar aguda.

Pulmonary embolism (PE) is an important disease entity in clinical medicine. It consists of obstruction of pulmonary arterial blood flow of a clot embolism from distant sites of the vasculature. Its incidence is variable depending on the source analyzed and most existing data is in hospitalized patients. The clinical presentation is a broad spectrum, from asymptomatic to cardiogenic shock with sudden death due to acute right heart failure. Recently it has been used to D-dimer as a useful laboratory test and a large negative predictive value in the diagnosis of PE. The current classification schemes recommended guided in clinical, laboratory and image. Chest angiotomography is currently the most commonly used diagnostic method for confirmation of pulmonary embolism, but the standard remains arteriography.

La tromboembolia pulmonar (TEP) es una entidad patológica de importancia en la medicina clínica. Consiste en la obstrucción del flujo sanguíneo arterial pulmonar por embolismo de un coágulo desde sitios distantes de la vasculatura. Su incidencia es variable dependiendo de la fuente analizada, la mayoría de los datos existentes son de pacientes hospitalizados. La presentación clínica tiene un espectro amplio, desde asintomática hasta el choque cardiogénico con muerte súbita debido a falla ventricular derecha aguda. En forma reciente se ha empleado al dímero D como un ensayo de laboratorio útil y con un gran valor predictivo negativo en el diagnóstico de TEP. Los esquemas de clasificación actuales recomiendan guiarse en parámetros clínicos, de laboratorio e imagen. La angiotomografía de tórax actualmente es el método diagnóstico más empleado para la confirmación de TEP, sin embargo, el estándar sigue siendo la arteriografía.

Nos últimos anos, o uso de testes de exercício é reconhecido como um método conveniente na avaliação da função respiratória em função da necessidade de se conhecer as reservas dos vários sistemas corporais a fim de que uma ideia mais completa sobre as capacidades funcionais do paciente seja obtida. Visto que o ato de andar é uma das principais atividades da vida diária, os testes de caminhada têm sido propostos para medir o estado ou a capacidade funcional do paciente. O teste de caminhada de seis minutos provou ser reprodutível e é bem tolerado pelos pacientes. Ele avalia a distância que uma pessoa pode percorrer sobre uma superfície plana e rígida em seis minutos e tem como principal objetivo a determinação da tolerância ao exercício e da saturação de oxigênio durante um exercício submáximo. Nesta revisão, apresentamos várias áreas clínicas nas quais o teste pode fornecer informações úteis.

Over the last few years, the use of exercise tests has come to be recognized as a convenient method of evaluating respiratory function, because the reserves of the various systems in the human body should be known in order to provide a more complete portrayal of the functional capacities of the patient. Because walking is one of the main activities of daily living, walk tests have been proposed in order to measure the state or the functional capacity of patients. The six-minute walk test has proven to be reproducible and is well tolerated by patients. It evaluates the distance a person can walk on a flat, rigid surface in six minutes. Its main objective is to determine exercise tolerance and oxygen saturation during submaximal exercise. In this review, we present various clinical areas in which the test can provide useful data.