State Health Director Loretta Fuddy died of a cardiac arrhythmia because of stress following a December plane crash off Molokai, a Maui County police spokesman said Monday.

Cardiac arrhythmia is a disturbance in the normal heart beat.

Fuddy, 65, was one of nine people who were on board a Makani Kai Cessna Grand Caravan that crashed into the ocean after take-off about a half-mile from Kalaupapa on Dec. 11 and the only passenger to die.

The pilot and all eight passengers made it out of the plane before it sank. But they had to float in the ocean until the Coast Guard and Maui County helicopters rescued them.

In the water, Fuddy held hands with Health Department deputy director Keith Yamamoto as he tried to help her relax, said Rev. Patrick Killilea, who consoled Yamamoto after the ordeal.

"He recounted how he said he helped Loretta into her life jacket and he held her hand for some time," the Kalaupapa priest said last month. "They were all floating together and she let go and there was no response from her."

The crash occurred when the single engine of the 2002 Cessna failed soon after it took off from Molokai and made its turn toward Honolulu.

An autopsy was conducted on Fuddy shortly after the crash, but the cause of death was initially deferred.

Her death was determined to be accidental, police said Monday.

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The Associated Press contributed to this story.