An Indiana woman who died following an altercation inside a Tim Hortons restaurant in Fort Wayne suffered an acute flare-up of congestive heart failure that occurred during the confrontation, according to the Allen County Coroner's Office, as reported by The New York Post.

Anita Grayson, 75, died after an incident on May 13 at a Tim Hortons location in Fort Wayne.

According to the coroner's office, her cause of death was determined to be "acute exacerbation of congestive heart failure in the setting of physical altercation."

The Allen County Coroner's Office classified Grayson's manner of death as "undetermined," concluding that the circumstances did not fit the legal definitions of a natural death, an accidental death, or a homicide.

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Allen County Coroner Dr. E. Jon Brandenberger explained the medical terminology used in the ruling during an interview with WANE 15.

“Acute exacerbation means that the heart failure suddenly got much worse,” Brandenberger said.

“So, it’s like an acute flare-up of congestive heart failure. Then that will cause symptoms and possibly lead to death.”

According to investigators, the confrontation began after Grayson became upset about her drive-thru coffee order.

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Police said she argued with a 17-year-old employee before becoming involved in a physical confrontation with a 20-year-old shift manager after being asked to leave the restaurant.

Investigators alleged that Grayson punched the shift manager, and the two became involved in a struggle on the floor.

Police also alleged that Grayson pulled out a chunk of the manager's hair before other employees intervened and separated the two.

After the altercation ended, Grayson sat at a table inside the restaurant and made a phone call, according to investigators.

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She later lay down on the floor. Employees checked on her, brought her water, and attempted to assist before she became unresponsive.

Emergency responders transported Grayson to a local hospital, where she was later pronounced dead despite lifesaving efforts by paramedics.

Brandenberger said the physical struggle likely intensified her pre-existing heart condition.

“The symptoms of congestive heart failure get worse when there is adrenaline flowing in a physical altercation, and then a sudden flare-up of the heart failure, which then can lead to symptoms, or hospitalization, and even death,” he said.

The coroner said his office carefully considered several possible manners of death before issuing its final determination.

“It’s not like she was sitting in her chair or walking through Kroger and died from congestive heart failure,” Brandenberger said.

“That would be natural. But there was something about this, the altercation, that made it unnatural.”

Investigators also evaluated whether the death should be classified as an accident or a homicide.

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“There has been exhaustive investigation and review in the evidence of this case,” Brandenberger said.

“The video was reviewed multiple times by the homicide detectives, by my staff, by the prosecutor, and by the forensic pathologist. Bodycam videos were reviewed. We listened to and transcribed the four 911 calls and multiple meetings.”

According to the coroner, the case did not meet the legal definition of homicide because Grayson died from congestive heart failure, and the autopsy found no "significant contributory injuries" resulting from the altercation.

Following the incident, Fort Wayne police released surveillance video of the confrontation without audio, stating it was intended to address misinformation circulating on social media.

Grayson's daughter, Tawnda Grayson, has publicly criticized the handling of the case and called for criminal charges against the employees involved in the confrontation.

“If our police here would just do what we pay our taxes for them to do, which is protect and serve, we wouldn’t be here,” Tawnda told WANE 15 during a protest after the incident.

“Y’all have to lock them up, y’all don’t understand. My mother is gone… I want justice for my mom.”

The family has retained civil rights attorney Ben Crump as it considers possible legal action.

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As of Tuesday, no Tim Hortons employees had been charged. The Allen County Prosecutor's Office said it will review the coroner's completed autopsy report before deciding whether criminal charges are warranted.

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