Fitzgerald had been an alcoholic since his college days, and became notorious during the 1920s for his extraordinarily heavy drinking, leaving him in poor health by the late 1930s. According to Zelda's biographer, Nancy Milford, Fitzgerald claimed that he had contracted tuberculosis, but Milford dismisses it as a pretext to cover his drinking problems. However, Fitzgerald scholar Matthew J. Bruccoli contends that Fitzgerald did in fact have recurring tuberculosis, and according to Nancy Milford, Fitzgerald biographer Arthur Mizener said that Fitzgerald suffered a mild attack of tuberculosis in 1919, and in 1929 he had "what proved to be a tubercular hemorrhage". It has been said that the hemorrhage was caused by bleeding from esophageal varices.
Fitzgerald suffered two heart attacks in the late 1930s. After the first, in Schwab's Drug Store, he was ordered by his doctor to avoid strenuous exertion. He moved in with Sheilah Graham, who lived in Hollywood on North Hayworth Avenue, one block east of Fitzgerald's apartment on North Laurel Avenue. Fitzgerald had two flights of stairs to climb to his apartment; Graham's was on the ground floor. On the night of December 20, 1940, Fitzgerald and Sheilah Graham attended the premiere of This Thing Called Love starring Rosalind Russell and Melvyn Douglas. As the two were leaving the Pantages Theater, Fitzgerald experienced a dizzy spell and had trouble leaving the theater; upset, he said to Graham, "They think I am drunk, don't they?"
The following day, as Fitzgerald ate a candy bar and made notes in his newly arrived Princeton Alumni Weekly, Graham saw him jump from his armchair, grab the mantelpiece, gasp, and fall to the floor. She ran to the manager of the building, Harry Culver, founder of Culver City. Upon entering the apartment to assist Fitzgerald, he stated, "I'm afraid he's dead." Fitzgerald had died of a heart attack. His body was moved to the Pierce Brothers Mortuary.
Among the attendants at a visitation held at a funeral home was Dorothy Parker, who reportedly cried and murmured "the poor son-of-a-bitch", a line from Jay Gatsby's funeral in Fitzgerald's The Great Gatsby. His body was transported to Maryland, where his funeral was attended by twenty or thirty people in Bethesda; among the attendants were his only child, Frances "Scottie" Fitzgerald Lanahan Smith (then age 19), and his editor, Maxwell Perkins. Fitzgerald was originally buried in Rockville Union Cemetery. Zelda died in 1948, in a fire at the Highland Mental Hospital in Asheville, North Carolina. Scottie Smith worked to overturn the Archdiocese of Baltimore's ruling that Fitzgerald died a non-practicing Catholic, so that he could be buried at the Roman Catholic Saint Mary's Cemetery where his father's family was interred; this involved "re-Catholicizing" Fitzgerald after his death. Both of the Fitzgeralds' remains were moved to the family plot in the cemetery of Saint Mary's Church, in Rockville, Maryland, in 1975.
Fitzgerald died before he could complete The Love of the Last Tycoon. His manuscript, which included extensive notes for the unwritten part of the novel's story, was edited by his friend, the literary critic Edmund Wilson, and published in 1941 as The Last Tycoon. In 1994 the book was reissued under the original title The Love of the Last Tycoon, which is now agreed to have been Fitzgerald's preferred title.