Food, fluid and air have to pass through the through a common point – the throat – to reach the gullet and airways. A small flap known as the epiglottis ensures that the airways are closed off while we swallow food and fluid. The choking reflex pushes out any food or fluid that may erroneously enter the airways at the outset to prevent it from going any further down.
However, sometimes these mechanisms are insufficient and food and fluid go down the ‘wrong pipe’ as it is commonly said. If a chunk of food is large and lodges in the airway, it can cause a person to choke to death unless lifesaving emergency procedures are implemented. This is known as café coronary syndrome.
There is a little more to café coronary syndrome than simply choking on a large piece of food although this is the main event that occurs. Firstly, a café coronary has nothing to do with a heart attack despite the term ‘coronary’. Secondly the events that lead to choking have a bit more to it than simply having the food go down the wrong pipe.
We all are aware of just how much we can swallow. If we take a large bite, we chew thoroughly till we break down the food in the mouth to a size that can be easily swallowed. However, should we bite off a larger piece than we can chew, or if we poorly judge the size of the bite and attempt to swallow a chunk of food, this can lead to a café coronary.
Café coronary really focuses on one main impairment – the choking reflex. Normally we would choke if we try to swallow too large a bite. Even before we attempt to swallow, our brain would tell us that this sized bite cannot be swallowed and we should chew it thoroughly or spit it out. In café coronary, this thought process and even the choking reflex is impaired.
This phenomenon was seen when people drank alcohol and mistakenly bit of a large piece of meat and attempted to swallow it. Intoxication having dulled both the mental process and choking reflex prevents the person from realizing that the bite is too large or allowing the body to push out the food before it enters the throat proper.
The piece of food enters the airway, lodges in the upper part by the vocal cords known as the glottis and obstructs air flow to and from the lungs. A person then suffocates. Talking and laughing while eating and a mix of alcohol all contribute to café coronary syndrome, which was at times thought to be due to a sudden heart attack.
Although a café coronary can occur for the same reasons as in younger adults, the elderly may have addition contributing factors that affects the thought process and reflexes. This includes diseases such as Alzheimer’s disease, Parkinson’s disease and stroke. A range of medication may also be a factor, especially tranquilizers, sleeping tablets and opioid painkillers, that can impair the normal choking reflex and mental processes.
It is therefore important that the elderly with any of these diseases or on medication should swallow carefully and preferably opt for softer and easier to swallow foods. Caregivers need to be aware of the dangers associated with taking too large a bite and force feeding. Although the Heimlich maneuver is a lifesaving procedure that can force out the trapped food, it may not always be easy for a caregiver to perform especially if a senior is in a wheelchair or bed ridden. In the event that a senior is alone when choking, there may be little chance of survival especially when they are less mobile.
Therefore café coronary syndrome should be remembered as a possible risk when eating or taking large bites of harder foods. Prevention is the key and the elderly should be realistic about their ability to chew and swallow without any risks. Rather opt for softer foods or cut up harder foods into very small pieces before eating, or even before cooking. Simple measures can prevent a café coronary from occurring in the elderly, which is at times a matter of life and death.