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The cardiovascular intensive care unit (CVICU) presents unique opportunities and challenges for integrating palliative care. A growing population of patients living longer with advanced cardiac disease, persistent symptoms, and functional limitations may benefit from early palliative involvement. With increasing use of advanced therapies such as mechanical circulatory support, many patients die in the CVICU, while survivors often experience long-term physical and psychosocial burdens. Despite evidence that early palliative care improves quality of life and reduces nonbeneficial interventions, it remains underutilized because of prognostic uncertainty and inconsistent referral guidance. This review explores therapies, palliative roles, and end-of-life practices in the CVICU.