Gene Hackman died primarily from heart disease, as confirmed by an autopsy, but he was also in advanced stages of Alzheimer's disease and had likely experienced prolonged fasting. The report highlights Hackman's compromised heart health, including congestive heart failure, a valve replacement, and an irregular heartbeat, managed with a pacemaker since 2019. Although Hackman tested negative for alcohol and drugs, a low acetone concentration indicated he hadn't eaten for an extended period, and he appeared to have lived about a week after his wife, Betsy Arakawa, who likely died from hantavirus pulmonary syndrome. Arakawa's online searches for flu symptoms suggest she was trying to manage her illness before her death. The investigation into their deaths involved interviews and searches for more evidence, including Arakawa's laptop, to understand the circumstances better.

The autopsy revealed Gene Hackman died mainly from heart disease, with additional complications from advanced Alzheimer's disease and evidence of prolonged fasting.

Hackman's heart condition was severe, involving congestive heart failure, aortic valve replacement, an irregular heartbeat, and a pacemaker implanted in April 2019.

His toxicology report showed he was negative for alcohol and intoxicating drugs, but the presence of low acetone suggested extended fasting.

Hackman's carbon monoxide levels were normal, and he tested negative for hantavirus, which likely caused his wife Betsy Arakawa's death a week earlier.

Arakawa's autopsy report was pending, but her internet activity included searches about flu-like symptoms, indicating she was attempting to understand her illness before dying.

Authorities conducted a thorough investigation, including interviews and searches of the Hackman home, to gather more information about their deaths.

The investigation highlighted the timeline of events, noting Hackman's pacemaker recorded abnormal heart rhythms on the day he likely died, Feb. 18.