A man with ischemic heart disease after consuming alcohol found collapsed while eating : a café coronary and intoxication, which cause preceded the others?
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Date
2017
Authors
Gangahawatte, S.
Edirisinghe, P. A. S.
Kitulwatte, I. D. G.
Journal Title
Journal ISSN
Volume Title
Publisher
University of Peradeniya, Sri Lanka
Abstract
Introduction
Complete and abrupt upper airway obstruction by a bolus of food, with sudden onset of symptoms simulating acute myocardial infarction was described as ‘Café coronary’ in early 60s. Victims are speechless and breathless; thus, without assistance (e.g.Heimlich manoeuvre) they will die.
A typical ‘café coronary’ was an obese middle aged man dying, while eating having a chest pain, with eye witness accounts of ‘choking on a piece of meat’ which was hurriedly eaten. Though various theories were postulated at that time regarding the mechanism, later studies showed that multiple factors could be associated.
We report a death of an alcoholic with a history of ischemic heart disease found with a bolus of food lodged at the pharynx and larynx.
Case Report
51 year-old male after having 11⁄2 bottles of illicit liquor, quarreled with the wife and left home, was found dead two (2) hours later in a partly built house. The examination of the scene revealed half a bottle of alcohol, a partly consumed loaf of bread, a beef curry and a roasted chicken thigh beside.
Autopsy revealed obstruction of the mid larynx with a piece of bread, mild laryngeal oedema, myocardial fibrosis, 80% narrowing of the anterior descending artery and a liquor smell from stomach. The toxicological screening revealed 200mg/dlethyl alcohol in the blood, while histology revealed fibrosis of the myocardium.
Conclusion
Although obstruction of the airway with a food bolus was the apparent cause of death at autopsy, the high blood alcohol level with myocardial fibrosis pauses questions regarding the mechanism of death i.e. which caused which? Therefore, a forensic pathologist should not be hurried to arrive at conclusions during the autopsy without further investigations.
Description
Keywords
Alcoholic , Ischemic heart disease , Bolus of food , Cafe coronary
Citation
Sri Lanka Journal of Forensic Medicine, Science & Law May 2017 Vol.8 No.1 P. 4 - 7