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A man with ischemic heart disease after consuming alcohol found collapsed while eating: a café coronary and intoxication. Which cause preceded the others?

Authors:

S. Gangahawatte ,

North Colombo Teaching Hospital Ragama, LK
About S.
Office of the JMO
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P.A.S. Edirisinghe,

Faculty of Medicine, University of Kelaniya, LK
About P.A.S.
Department of Forensic Medicine
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I.D.G. Kitulwatte

Faculty of Medicine, University of Kelaniya, LK
About I.D.G.
Department of Forensic Medicine
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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 1½ 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.

How to Cite: Gangahawatte, S., Edirisinghe, P.A.S. & Kitulwatte, I.D.G., (2017). A man with ischemic heart disease after consuming alcohol found collapsed while eating: a café coronary and intoxication. Which cause preceded the others? . Sri Lanka Journal of Forensic Medicine, Science & Law . 8 ( 1 ) , pp . 4–7 . DOI: http://doi.org/10.4038/sljfmsl.v8i1.7787
Published on 30 Jun 2017.
Peer Reviewed

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