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Defense testimony goes to heart woes; Caceres jury hears from medical experts.

Byline: Gary V. Murray

WORCESTER - An expert witness for the defense testified yesterday that there was no way of knowing whether the onset of the cardiac arrhythmia that claimed Jose L. Alvarado's life occurred before or during a physical altercation on the morning of Oct. 15, 2006, in Denny's restaurant on Lincoln Street.

Dr. Jennifer Lipman, a pathologist and former state medical examiner, told a Worcester Superior Court jury that the emotional stress of preparing to engage in either a physical or verbal confrontation could have precipitated the arrhythmia and sudden cardiac arrest suffered by Mr. Alvarado, particularly in light of his poor health.

The testimony of Dr. Lipman, a defense witness taken out of turn to accommodate her schedule, came during the fifth day of Maico R. Caceres' trial on murder and assault charges in the death of the 36-year-old Mr. Alvarado.

Mr. Caceres, 23, of 12 Beaver Brook Parkway, is one of four Worcester men charged with murdering Mr. Alvarado and assaulting him and his brother, Joseph Pena, during the early morning brawl just over two years ago in Denny's at 494 Lincoln St. Mr. Caceres, who told police he acted in self-defense, allegedly slapped Mr. Alvarado in the face and hit him in the head with a chair during the melee.

The prosecution contends that the physical stress of the trauma inflicted upon Mr. Alvarado induced his heart attack.

Dr. Henry Nields, the medical examiner who performed the autopsy on Mr. Alvarado, testified before Dr. Lipman that Mr. Alvarado suffered "sudden death during physical altercation due to hypertensive cardiovascular disease."

Dr. Nields, the state's acting chief medical examiner, said under questioning by Assistant District Attorney Lawrence J. Murphy that Mr. Alvarado's pre-existing health problems included obesity, an enlarged heart, coronary heart disease, high blood pressure and hypertension.

He said the physical injuries he observed during the autopsy included small cuts over Mr. Alvarado's right eye and on the back of his head and bruises over his right eye, on the right side of his head, on the underside of his jaw, on both sides of his chest and on his legs.

Under cross-examination by Louis P. Aloise, one of Mr. Caceres' lawyers, Dr. Nields said none of the injuries, in and of themselves, would have been life-threatening. Dr. Nields also agreed with Mr. Aloise's suggestion that the emotional stress of preparing to fight could cause an irregular heartbeat in a person in Mr. Alvarado's condition.

But when Mr. Aloise went on to suggest that there was no way of determining whether Mr. Alvarado's heart episode began as he was preparing to fight or engaged in combat, Dr. Nields responded, "In this case, I believe the physical part of the altercation played an important role in his arrhythmia."

Dr. Lipman said, in response to questions posed by defense lawyer Michael C. Wilcox, that there was no way of determining from an autopsy whether Mr. Alvarado's cardiac arrhythmia began before or after he was struck.

Testimony in the case is scheduled to resume today.

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Title Annotation:LOCAL NEWS
Publication:Telegram & Gazette (Worcester, MA)
Date:Nov 19, 2008
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