A 42-year-old woman presents to the emergency department with acute dysphagia and retrosternal chest discomfort that began 4 hours ago while eating steak. She reports the food feels "stuck" in the mid-chest. She is unable to swallow saliva and is expectorating into a basin. She denies shortness of breath or abdominal pain. Past medical history is significant for allergic rhinitis and intermittent solid-food dysphagia for the past 3 years, for which she drinks water to "wash it down." She has no history of esophageal surgery. She takes cetirizine daily.

She is afebrile. Her pulse is 92 bpm, respirations are 18/min, and blood pressure is 138/86 mm Hg. She is visibly anxious and spitting saliva into a cup. She has no stridor or respiratory distress.