Robin Miller, DNP, MPH, ACNP, and Nilesh Patel, MD, discuss the burden of heart failure and ischemic disease as well as risk stratification and revascularization strategies. They present case studies of medical and surgical approaches to revascularization including a 55-year-old male with cardiogenic shock supported with Impella 5.5® with SmartAssist®, a 76-year-old male requiring emergent bailout Impella® support and an 86-year-old undergoing Protected PCI with rotational atherectomy and bifurcation stenting. Robin Miller is an acute care nurse practitioner currently practicing in advanced heart failure at Providence St. Vincent Medical Center, in Portland, Oregon. Dr. Patel is an interventional cardiologist at Springfield Clinic in Springfield, Illinois.