How Cardiac Arrest Can Mimic Choking To Death

Megan M. Hamilton MS CCC-SLP, the forensic Speech Language Pathologist (SLP) at Lios Manhe LLC, is experienced in analyzing a variety of medical conditions and their effect on airway protection and swallow function.  SLPs do not determine cause of death but offer insight on whether the events documented are consistent with aspiration, airway blockage and choking to death.   

A choking death secondary to obstruction of the airway by food material occurs over a period of time, typically between three and six minutes, and manifests signs of asphyxiation.  Heart attack/Myocardial Infarction/Myocardial Ischemia/Cardiac Arrest is the depletion of oxygen to the heart muscle with death of heart tissue typically causes the stricken individual to pass out and collapse within seconds with death occurring in a short period of time.  Myocardial Infarction does not manifest signs and symptoms of choking.   

Cardiac arrest does mimics choking through food material being found in the trachea or larynx during autopsy or resuscitative efforts.  Nausea and Vomiting are nonspecific gastrointestinal symptoms that occur during a heart attack with some regularity.  Although the exact number of patients who suffer these symptoms is not known, one study demonstrated that about 69% of people who have a heart attack in the lower-back portion of the heart report nausea and vomiting, while only about 27% of those who have a heart attack in the front portion of the heart experience the same problems.   Studies to date are not consistent in percentages or cardiac locations but are consistent in demonstrating nausea and vomiting during a heart attack. 

The trachea and esophagus are anatomically adjacent with only the upper esophageal sphincter (UES) preventing material from exiting the esophagus and entering the trachea. During vomiting, the UES is open, thus the expulsion of material from the stomach through the esophagus and into the pharynx and ideally out the mouth. Material in the pharynx can enter the trachea or be held in the pyriform sinuses and later breathed into the airway or appear to block the trachea. 

Increasing the likelihood of aspiration of stomach contents is the fact that more than half the patients in cardiac arrest gasp. This gasp is a survival reflex triggered by the brain and can increase the chances of survival for someone in cardiac arrest.  It also serves to capture any materials in the oral cavity, pharynx or larynx and pull that material into the trachea and lungs.  During this gasp, large chunks of material can enter the trachea and either occlude the airway or give the appearance of occluding the airway.   

Megan M. Hamilton, MS, CCC-SLP, earned her Master of Science degree from Marquette University and holds a lean six sigma green belt from Purdue University as well as a Certificate of Clinical Competence from the American Speech Language and Hearing Association (ASHA).  Megan currently provides consultation to hospital speech language pathology and serves as a forensic medical SLP throughout the United States.  Megan has held positions as direct care provider, site manager, regional vice president, and division manager of clinical education for national rehabilitation providers in long term care, sub acute, and pediatric care.   She brings over 30 years of experience to her clients.

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