Background Clinical manifestations of pheochromocytoma (PCC) frequently are not specific and can be attributed to other pathologies. The most dreaded manifestation is catecholamine-induced cardiomyopathy. A prompt diagnosis, sometimes extremely problematic due to associated conditions of the patient, is essential for clinical outcomes, because early resection of PCC may prevent progression to irreversible cardiac remodelling. Case summary We present a case of 47-year-old woman with suspected acute coronary syndrome but intact coronary vessels. Electrocardiogram examination showed ST depression suggestive for coronary ischaemia. Echocardiography revealed reduced ejection fraction of left ventricle and global hypokinesis. Abdominal ultrasound examination determined multiple cysts in liver and both kidneys. The patient had unclear transient states of sudden sweating, pale skin, nausea, and vomiting accompanied by hypertensive crisis. Fractioned urinary metanephrines were considerably increased. Contrasted computed tomography of abdominal cavity and pelvis revealed in both liver lobes many cysts; both kidneys showed multiple cysts too; in the right adrenal gland was detected a filling defect. Computed tomography findings have established diagnosis of adrenal PCC of right gland associated with liver and kidney polycystic disease. Discussion Phechromocytoma, with primary manifestation as catecholamine-induced cardiomyopathy, in patient with polycystic kidney and liver disease could represent a really challenging diagnosis. Clinical manifestations of PCC frequently are not specific and can be explained by associated pathologies. This is the second case of adrenalectomy due to PCC associated with polycystic kidney and liver disease reported in the medical literature.

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Purpose: To evaluate the quality of NSTEMI care in AMI centers and to identify potential gaps in the management of patients with this diagnosis. Material and methods: 550 patients with NSTEMI, hospitalized in 3 coronary angioplasty centers were enrolled in the study. The information was collected using a questionnaire composed of 179 questions, developed according to the standards of the EORP NSTEMI Registry. The research took place in two stages: retrospective observational study during 2019 and prospective - in the period 01.2020-09.2022. Results. The NSTEMI rate from the total number of patients hospitalized with AMI in the Institute of Cardiology and SP Novamed, in the period 2019-2022 was 21,6%. The results of the evaluation of NSTEMI management in the studied AMI centers are close to those reported by equivalent international registries (EORP NSTEMI, FAST-MI, PLACS, MINAP), excepting some differences in certain chapters: the diagnostic strategy of NSTE-ACS, risk stratification, diagnosis and treatment of hypercholesterolemia and the antiplatelet treatment indicated at discharge. The mortality rate in the hospital was 4,2%, at 30 days m8k– 6,0%, at 6 months after hospitalization – 10,2%, and at 12 months – 12,8%. Conclusions. The rate of NSTEMI in the Republic of Moldova is lower than that reported by the international registers of IMA, while the mortality indicators are higher. These discrepancies are largely explained by gaps in NSTEMI management identified within the studied AMI centers.