Medical futility refers to interventions that are unlikely to produce any significant benefit for the patient. Medical and technological resources allow many patients affected by advanced cardiovascular diseases to receive more aggressive and expensive treatments than ever before. This wide range of available options can frequently lead to the delay of complex end-of-life decisions, such as starting palliative care programs. Medical futility is a daily problem, with significant ethical implications and concerns about the respect of the main ethics points: non maleficence, patient's autonomy, and justice. This paper examines some considerations and applications of the concept of medical futility, particularly about the various definitions of futility, the complexities of management when care is considered futile and the ethical and clinical criteria to withdrawing or withholding aggressive treatments. The patient-centered care, based on physician-patient communication, seems to be the best approach to this problem, even with a patient with advanced heart disease. Finally, the increasing power of technology and its relationship with the current cultural values of the developed societies are outlined, particularly when end-of-life decisions are addressed.