Café coronary syndrome refers to sudden death from food bolus impaction at the laryngopharynx. Which vagal reflex mediates the rapid cardiovascular collapse seen in these cases BEFORE hypoxia becomes lethal?

• A Laryngeal-vagal reflex — stimulation of superior laryngeal nerve afferents triggering reflex cardiac arrest ✓
• B Bezold-Jarisch reflex — stretch receptors in ventricles causing bradycardia
• C Hering-Breuer reflex — pulmonary stretch receptors inhibiting inspiration
• D Valsalva manoeuvre response — increased intrathoracic pressure reducing venous return

Explanation

In café coronary syndrome (foreign body airway obstruction), mechanical stimulation of the supraglottic mucosa and epiglottis activates afferents of the superior laryngeal nerve (branch of vagus). This triggers a powerful laryngeal-vagal reflex arc causing severe bradycardia or cardiac arrest through efferent vagal cardioinhibitory signals — death can be instantaneous, before hypoxia develops. This is why some café coronary victims collapse without even developing cyanosis. Heimlich manoeuvre is the first-aid intervention; the abrupt rise in intrathoracic pressure dislodges the bolus.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.