In this next case scenario a 70-year-old man is known with a 20-year history of hypertension, a 15-year history of type 2 diabetes mellitus, a myocardial infarction eight years ago and a five-year history of congestive heart failure.  He was admitted to the hospital with worsening shortness of breath.  Over the five past days he had noticed increased swelling in his legs and had developed a cough productive of clear sputum.  He was admitted with a diagnosis of an exacerbation of congestive heart failure.  Unfortunately, despite aggressive diuresis, he progressed to decompensated heart failure requiring inotropic support.  He remained hemodynamically unstable and died six days after admission.

• Congestive cardiac failure is the immediate cause of death on line A of Part 1.
• Ischaemic heart disease is the underlying cause of the heart failure, so it is reported on the lowest used line of Part 1.
• In this case hypertension and diabetes mellitus would go in Part 2 as contributing factors to death.