Café coronary syndrome-fatal choking on ‘BANANA’

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. Café coronary syndrome, which was first reported as a sudden collapse at restaurants while dining, was found to be due to fatal occlusion of the upper airway by large pieces of food. Many individuals affected had consumed large amounts of alcohol prior to the incident. However, the same condition has also been noticed among the institutionalized elderly with neurologic and psychiatric conditions. The diagnosis of café coronary syndrome can only be made with confidence after the clinical history and circumstances of death have been clearly established, impacted material has been demonstrated in the airway at autopsy, risk factors have been identified and other possible causes of death have been excluded. There is no specific autopsy finding that is indicative of café coronary syndrome. Therefore, autopsy examination should not only attempt to demonstrate airway occlusion by a bolus of food or foreign body, but also identify underlying risk factors such as an acute intoxication, use of dentures or poor dentition, and neurologic or psychiatric conditions. This case report is an un-witnessed death caused by café coronary syndrome, where a 65 year-old woman was found dead in her bed, last seen having dinner the previous night. At autopsy, a piece of banana weighing 18 grams was found to be impacted within the laryngophrarynx, occluding the airway. She was edentulous and had a history of psychiatric conditions. This case highlights the need of being aware of the condition, especially in the elderly with mastication problems and psychiatric conditions due to lack of teeth as well as other deglutition problems. This data indicates that continued efforts toward greater awareness of the café coronary syndrome is still necessary. Special attention should be directed to the predisposing role of the institutionalized elderly with psychiatric conditions.