A Texas medical examiner determined that "acute mixed drug ingestion" contributed to the death of three-time world surfing champion Andy Irons of Kauai, according to the family’s summary of the autopsy report.

Irons, 32, died in a Dallas hotel room on Nov. 2. The family did not release the actual 13-page report Wednesday and instead quoted Dr. Vincent Di Maio, a forensic pathologist from San Antonio, whom they asked to "review and explain" it.

Tarrant County Medical Examiner officials could not be reached for comment Wednesday night and previously said the report would not be released until June 20, after a ruling from a district judge.

Di Maio said the cause of death was "sudden cardiac arrest" and he disputed the medical examiner’s conclusion that drugs were a "second cause" of death. "The manner of death is in fact labeled natural," according to the family.

However, the family acknowledged that Irons did use both prescription and recreational drugs.

The report listed a combination of drugs that included methadone, Xanax, a trace amount of methamphetamine and a byproduct of cocaine, the family’s statement said.

"Andy was prescribed Xanax and zolpidem (Ambien) to treat anxiety and occasional insomnia — a result of a bipolar disorder diagnosed by his family doctor at age 18. This is when Andy first began experiencing episodes of manic highs and depressive lows," the statement said. "The family believes Andy was in some denial about the severity of his chemical imbalance and tended to blame his mood swings on himself and his own weaknesses, choosing to self-medicate with recreational drugs. Members of his family, close friends and an industry sponsor intervened over the years to help Andy get clean, but the effort to find balance in his life was certainly complicated by his chemical makeup."

Irons was on his way back to Hawaii on Nov. 2 after withdrawing from a surfing tournament in Puerto Rico.

In the hotel room, police discovered prescription bottles for alprazolam, used for anxiety, and zolpidem, a sleeping aid. On the day of his death, a Tarrant County medical examiner’s official told the Star-Advertiser that tablets suspected to be methadone, commonly used to treat opiate addiction, were found in containers for other prescription medicines.

Relatives originally said they believed Irons was suffering from dengue fever. They said Wednesday that dengue fever was ruled out, but Irons did suffer from flulike symptoms in Puerto Rico, where he withdrew from the Rip Curl Pro Search leg of the ASP World Tour.

Di Maio said in the family’s statement that Irons died of a heart attack due to "hardening of the arteries" that produced 70 percent to 80 percent narrowing of one artery in his heart.

"A plaque of this severity, located in the anterior descending coronary artery, is commonly associated with sudden death," Di Maio said in the statement.

Deaths due to coronary atherosclerosis usually begin to appear in the late 40s, but "individuals such as Mr. Irons have a genetic predisposition to early development of coronary artery disease," Di Maio said. "In about 25 percent of the population, the first symptom of severe coronary atherosclerosis is sudden death."