Palliative care is a holistic approach to patient care that integrates medical, physical, psychosocial, and spiritual elements into the care of patients with serious illness. With advancing technology, healthcare has seen an increase in ethics and palliative-related conversations. Palliative-related discussions within the cardiac intensive care unit (CICU) focus on advance care planning, improving symptom control, caregiver support and family-centered care, chaplain and religious considerations, decision-making capacity, device failure, deactivation of implanted cardiac devices, and much more. In this setting, early specialized inpatient palliative care involvement is integral to navigating these challenges as well as supporting an interdisciplinary approach of all medical specialties. With more recent support and guidance from scientific societies, the niche of specialty inpatient palliative care has grown into a trusted medical specialty that continues to play a keen role within cardiac intensive care units. Similarly, the utilization of mechanical circulatory support devices is increasing and more ethical dilemmas are occurring and require the programmatic involvement of specialty palliative care to help improve advance care planning, support caregivers and family, and ensure that patients’ dignity is preserved throughout the trajectory of their illness. Moreover, hospitals generally see increased positive patient outcomes as the specialty aims to help patients ease their burden of symptoms, improve length of stays, and decrease mortality rates.