The patient develops symptoms either immediately after swallowing a large mouthful of food (usually inadequately chewed meat) or as the result of intoxication, wearing dentures, or being too embarrassed to spit out a large piece of gristle. The patient often develops substernal chest pain that may mimic the pain of a myocardial infarction. This discomfort increases with swallowing and is followed by retention of salivary secretions, which, unlike infarction, leads to drooling. The patient usually arrives with a receptacle under the mouth, into which he’s been repeatedly spitting. At times these secretions will cause paroxysms of coughing, gagging, or choking. Often the patient can readily tell you where the food has become stuck by pointing to the lower esophagus.