Nowadays, heart Failure (HF) is one of the main contributors of cardiovascular morbidity and mortality, this faces us with great challenges. The heart-kidney interaction receives particular attention due to the development of the so-called cardiorenal syndrome (CRS) and the diuretic resistance, latter is a predictor of adverse events in acute HF and is independent of the glomerular filtration rate. Development of diuretic resistance is secondary to multiple causes, so a comprehensive evaluation of all of them is required. In recent years, congestion has become relevant within the pathophysiological mechanism of CRS, as it mutually generates and perpetuates damage in these two organs. Given the importance of congestion, diuretics remain the cornerstone of treatment, although their use is largely empirical due to the limited evidence available. The evidence-based treatment paradigm is elus...

Nowadays, heart Failure (HF) is one of the main contributors of cardiovascular morbidity and mortality, this faces us with great challenges. The heart-kidney interaction receives particular attention due to the development of the so-called cardiorenal syndrome (CRS) and the diuretic resistance, latter is a predictor of adverse events in acute HF and is independent of the glomerular filtration rate. Development of diuretic resistance is secondary to multiple causes, so a comprehensive evaluation of all of them is required. In recent years, congestion has become relevant within the pathophysiological mechanism of CRS, as it mutually generates and perpetuates damage in these two organs. Given the importance of congestion, diuretics remain the cornerstone of treatment, although their use is largely empirical due to the limited evidence available. The evidence-based treatment paradigm is elus...

El signo electrocardiográfico Spiked Helmet (SHS) ha sido descrito en pacientes críticamente enfermos asociándose con alto riesgo de muerte. Presentamos el caso de un joven con síndrome de Marfan, quien a las 72 h del periodo posquirúrgico de un aneurisma de aorta abdominal roto, presentó un cuadro compatible con miocardiopatía de Takotsubo y la manifestación electrocardiográfica de SHS. En este caso, los factores fundamentales que pueden justificar la presentación de este patrón electrocardiográfico son la intervención quirúrgica toraco-abdominal y la miocardiopatía de Takotsubo, que en conjunto activaron el sistema simpático de manera intensa desencadenando esta manifestación clínico-electrocardiográfica.