Maui County police says the late state health director Loretta Fuddy died due to cardiac arrhythmia as a result of stress after a Makani Kai Air plane crashed off of Molokai last month.
An arrhythmia is a problem with the rate or rhythm of the heartbeat.
Fuddy's death has been ruled as accidental.
On Dec. 11, the plane lost power off of Kalaupapa. Nine people were on board the plane including Fuddy. The pilot and seven other passengers survived the crash.
The pilot and a passenger who swam to shore have said Fuddy appeared fine while bobbing in the water after everyone exited the plane and waited for help to arrive.
Fuddy's brother, Lewis Fuddy, says she was healthy and didn't have any known heart problems.
The National Transportation Safety Board is investigating the crash. Its preliminary report says the plane floated for about 25 minutes before sinking.