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A man in his 50s known to have heart failure with left ventricular assist device presented after a suicide attempt by cutting the device’s driveline at home. This occurred in the context of functional decline, dependence for basic care and perception of being a burden on his family. He had no prior psychiatric history but had expressed passive death wishes for weeks prior to the attempt, overlooked by both family and clinicians. He was admitted for cardiac stabilisation and psychiatric evaluation and started on sertraline for treatment of generalised anxiety and depression. This case highlights the psychological toll of advanced heart failure and device dependence, particularly when compounded by sudden loss of autonomy. Learning points include the need for early psychiatric evaluation and integration of palliative care in patients receiving life-sustaining cardiac devices. Routine screening for demoralisation, depression and suicidal ideations in this population could prevent catastrophic outcomes and improve patient dignity and quality of life.