Occasionally the person has a physiological lesion of the conductive system of the heart predisposing to and cause arrhythmias, which can be aggravated by alcohol and release of Catecholamines. Peak levels of Catecholamines are reached immediately after the struggle.
After a violent struggle, the victim may be restrained in such a way, that the breathing is impaired, producing a relative hypoxia. In some persons, death may result, when this is combined with alcohol and the release of Catecholamines. The cause of death is certified as "Cardiopulmonary Arrest" caused by a violent struggle. Intoxicated person who is severely beaten about the face may collapse and die. Death in this case occurs from a combination of CNS depression due to alcohol and diffuse axonal injury from beating.
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