When I eat or drink liquids, I sometimes choke and have trouble breathing. I choke so hard I throw up and get needles and pins all over my body and it makes my heart hurt. Little pieces of food, like crumbs, hit a certain spot in my throat and set it off. I can't clear my throat because I still cough and choke. It gets very scary because I have heart problems. Is this a normal thing?

A.W.

This happened to me once when I was in training. Picture this: Five doctors in a call room, chowing down on some greasy take-out Thai food, and one starts choking and gasping in obvious distress. What do the other four doctors do? Does one of them hop up and quickly perform a Heimlich maneuver? No! They gape at the gasping doctor in utter amazement!

Actually, the Heimlich maneuver would have been a mistake. I wasn't really choking on my food; I was in laryngospasm. While gulping down my steamed white rice, I had an esophageal spasm (a condition in which food lodges, suddenly and painfully, in a "cramped" esophagus) and tried to wash it down with some cola. Rather than push the food down, the cola popped right back up and spilled over into my larynx (voice box). My larynx did what any respectable larynx should do under such circumstances: The vocal cords slammed shut to prevent food and drink from entering my lungs. This is laryngospasm.

In your case, laryngospasm is occasionally occurring when you swallow. In lay terms, your food and drink are "trying to go down the wrong way," and the vocal cords are forcefully closing to prevent this foreign material from entering your lungs. Why is this occurring? There are many possible explanations for why your swallowing mechanism is malfunctioning.

Should you be concerned because of your heart problems? I'm afraid so. Every time this happens, you are powerfully stimulating your vagus nerve. This is a nerve that provides sensation to the larynx. Intense vagal stimulation can also affect the heart rate and rhythm. In some individuals, this could be dangerous. I cannot judge the potential seriousness of this problem; too much depends on the exact nature of your heart condition.

You need to first discuss this problem with the doctor who treats your heart problem. Share this column with him or her. You will almost certainly need further studies to determine the nature and cause of your swallowing problem, but first you need your family physician or internist to take a careful history and perform a physical examination that is appropriate to this problem. Following this, your physician might decide that you need to be evaluated by a specialist, such as an ENT (ear, nose and throat doctor) or a gastroenterologist.