Cafe Coronary Syndrome-fatal Choking on Food: A Case Report

Authors

  • Mahesh Chand Meena Assistant Professor, Department of Forensic Medicine & Toxicology, UCMS&GTB Hospital, New Delhi, India
  • Sunil Naagar Professor, Department of Forensic Medicine & Toxicology, Dr BSA Medical College & Hospital, New Delhi, India
  • Suman PG Resident, Department of Forensic Medicine & Toxicology, UCMS&GTB Hospital, New Delhi, India
  • Mukesh Kumar Bansal Assistant Professor, Department of Forensic Medicine & Toxicology, Rani Durgawati Medical College Banda, Uttar Pradesh, India

DOI:

https://doi.org/10.48165/

Keywords:

Choking, Intoxication, Cafe coronary

Abstract

Cafe Coronary syndrome which was first reported as sudden collapse at restaurants while dining was found to be due to fatal occlusion of upper airway by large pieces of food. Many of those individuals had consumed large amounts of alcohol prior to the incident. Choking to death means asphyxiation by blockage of the internal air passages. If it occurs while eating, it is also called café coronary syndrome because it presents like an acute heart attack due to coronary obstruction. Sudden collapse during or shortly after a meal should always raise the possibility of café coronary and the autopsy examination should not only attempt to demonstrate airway occlusion by a bolus of food, but also to identify or exclude underlying neurological disease. A 27-year-old individual waiter had dinner in a restaurant after finishing his work. While eating a piece of meat, the man collapsed lifelessly. On internal examination, a piece of mutton bone was found in the larynx (3.5 x 1.4 cm) between the epiglottis and the vocal cords which was nearly complete obstruction of the larynx. The suppression of gag-reflex due to alcohol or drugs makes the individual susceptible to Cafe Coronary. This case highlights the need of being aware of the condition especially in the alcoholic/ intoxicated persons. 

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References

[1] Haugen RK. The cafe coronary: sudden deaths in restaurants. JAMA. 1963;186:142–144.

[2] Mittleman RE. Fatal choking in infants and children. The American Journal of Forensic Medicine and Pathology. 1984;5:201-210.

[3] Mittleman RE, Wetli CV. The fatal cafe coronary. Foreign body airway obstruction, JAMA. 1982;247:1285.

[4] Berzlanovich A, Muhm M, Sim E, Bauer G. Foreign body asphyxiation-an autopsy study. The American Journal of Medicine. 1999;107:351-355.

[5] Wick R, Gilbert J, Byard R. Cafe coronary syndrome-fatal choking on food: an autopsy approach. Journal of Clinical Forensic Medicine. 2006; 13:135-138.

[6] Irwin R, Ashba J, Braman S, Lee H, Corrao W. Food asphyxiation in hospitalized patients. JAMA. 1977;237: 2744-2745.

[7] Althoff H, Dotzauer G. Zur. The problems of deaths by bolus aspiration (cafe-coronary). Z Rechtsmed. 1976;78: 197-213.

[8] Berzlanovich AM, Fazeny-Dorner B, Waldhoer T, Fasching P, Keil W. Foreign body asphyxia: a preventable cause of death in the elderly. American Journal of Preventive Medicine. 2005;28: 65–69.

[9] Boczko F. Patients’ awareness of symptoms of dysphagia. Journal of the American Medical Directors Association. 2006;7:587–590.

[10] Samuels R, Chadwick DD. Predictors of asphyxiation risk in adults with intellectual disabilities and dysphagia. Journal of Intellectual Disability Research. 2006;50:362–370.

[11] Byard R. Coprophagic café coronary. The American Journal of Forensic Medicine and Pathology. 2001;22:96-99.

[12] Hunsaker D, Hunsaker J. Therapy-related café coronary deaths: two case reports of rare asphyxial deaths in patients under supervised care. The American Journal of Forensic Medicine and Pathology. 2002;23:149-154.

[13] Finestone HM, Fisher J, Greene-Finestone LS, Teasell RW, Craig ID. Sudden Death in the dysphagic patient-a case of airway obstruction caused by a food bolus: a brief report. American Journal of Physical Medicine & Rehabilitation. 1998;77:550–552.

[14] National Safety Council. Injury facts. Edition 2005–2006. Itasca, Ill: National Safety Council; 2006.

[15] Haugen RK. The cafe coronary. Sudden death in restaurants. JAMA. 1963;186:142–143.

[16] Reimann W, Prokop O, Geserick G. Vademecum Gerichtsmedizin. 4th ed. Berlin: Volk und Gesundheit; 1985.

[17] Enwo ON, Wright M. Sausage asphyxia. International Journal of Clinical Practice. 2001; 55:723–724.

[18] Pinheiro J, Cordeiro C, Vieira DN. Choking death on a living ûsh (Dicologoglossacuneata). The American Journal of Forensic Medicine and Pathology. 2003;24:177–178.

[19] Pekka Saukko and Bernard Knight Arnold. Suffocation and asphyxia in Knight’s Forensic Pathology eds., London 3rd Ed pp 361-363.

[20] Clerf LH. Historical aspects of foreign bodies in the air and food passages. South Medical Journal. 1975;68:1449-1454.

[21] Bockholdt B, Ehrlich E, Maxeiner H. Forensic importance of aspiration. Leg Med (Tokyo). 2003; 5:311–314.

[22] Jacob B, Wiedbrauck C, Lamprecht J, Bonte W. Laryngologic aspects of bolus asphyxiation-bolus death. Dysphagia. 1992;7:31–35.

[23] Schmitt MF, Hewer W. Life threatening situations caused by bolus aspiration in psychiatric inpatients—clinical aspects, risk factors, prevention, therapy. Fortschr Neurol Psychiatr. 1993;61:313-318.

[24] Byard RW. Unexpected death due to acute airway obstruction in daycare centers. Pediatrics. 1994;94:113–114.

[25] Byard RW. Mechanisms of unexpected death in infants and young children following foreign body ingestion. Journal of Forensic Sciences. 1996;41:438–441.

[26] Byard R, Gilbert J, Gibbs S, Kemper C. Cetacean café coronary. Journal of Clinical Forensic Medicine. 2003;10:85-88.

[27] Hsieh H, Bhatia S, Andersen J, Cheng S. Psychotropic medication and nonfatal cafe coronary. Journal of Clinical Psychopharmacology. 1986;6:101-102.

[28] Chaumartin N, Monville M, Lachaux B. Dysphagia or dysphagias during neuroleptic medication? Encephale. 2012;38:351-355.

Published

2022-01-30

How to Cite

Cafe Coronary Syndrome-fatal Choking on Food: A Case Report . (2022). Indian Internet Journal of Forensic Medicine and Toxicology, 19(3&4), 76–80. https://doi.org/10.48165/