Fiona Christine Swann was found in a pile of blankets and sleeping bags along with three other people on the morning of January 8 this year.
Wakefield Coroner’s Court heard how Yorkshire Ambulance Service had received a call about a homeless person in the Dark Arches, off Neville Street.
In a written statement, paramedic Jonathan Millward said: “Members of the public were passing by with what appeared to be no concern.”
On closer inspection, he found three people under the blankets who seemed to be using Ms Swann "as a pillow".
Mr Millward described how he roused the others, one of whom told him that she had last spoken about an hour earlier.
He found there were no signs of life and did not attempt resuscitation, but her body was still warm.
Police initially used descriptions in their records to identify 56-year-old Ms Swann, who had a missing finger and a right leg amputated below the knee.
A key found in her pocket also opened the door to her last recorded address in Prosper Street, Hunslet.
Officers found the property was empty but in a poor state of repair, with a number of hypodermic needles strewn about inside.
Senior coroner Kevin McLoughlin said: “It is an immensely sad situation that we have someone who has an address provided by the local authority but chooses not to live there, that it is in a poor state of repair and they choose to live on the streets.”
The court heard Ms Swann was born in Halifax and had registered with the York Street Health Practice in Leeds in 1998 under the name Fiona Watson.
She had a history of depression and opiate dependence, and spent several months in intensive care after falling ill with pneumonia in October 2006.
Her right leg was amputated below the knee in March 2007 and she began to use a wheelchair at that time.
Practice records showed she last made contact by phone in February 2017 when she told staff she was being supported by a partner and would seek an appointment with drug and alcohol service Forward Leeds.
However, Forward Leeds said they had lost contact with Ms Swann in January 2017 and she never returned to the service.
Pathologist Dr Lisa Barker told the court that there was no evidence of a physical assault or hypothermia, but toxicology tests had found cocaine in Ms Swann’s system.
She said a post-mortem examination found signs of heart disease and some liquid on her lungs, which can occur when the heart goes into an "abnormal state".
“I felt the most likely cause of the death was her underlying heart disease but that would have been worse because she used cocaine,” she said.
Mr McLoughlin said Miss Swan had been pronounced dead in Neville Street at around 9am on January 8.
"It is understood she had been sleeping rough," he said. "She was known to use illicit drugs but had not engaged with the drug and alcohol service since 2017 and had not seen her GP since 2011."
He concluded the cause of death was natural, with the main cause recorded as heart disease and cocaine use being a contributing factor.
"It is astonishingly sad that someone should die in these circumstances," he added.