Remote Ischemic Preconditioning for Renal and Cardiac Protection in Congestive Heart Failure (RICH) Trial

Inclusion Criteria: * Age 18 years * Diagnosis of heart failure with reduced LVEF \<50% * Pre-procedure intravenous normal saline fluid restriction status * Society for Cardiovascular Angiography and Interventions (SCAI) AKI risk score (\>1%) * Referral for coronary angiogram and/or PCI * Suspected stable coronary artery disease or acute coronary syndrome Exclusion Criteria: * Inability to give informed consent * Unstable BP (SBP \> 200 or \<80 mmHg) at the time of enrolment * Upper limb peripheral arterial disease * Unavailability of at least one arm for RIPC/Sham-RIPC application * Kidney transplant * Renal disease requiring dialysis * Prior exposure to contrast media within 72hrs preceding coronary angiography * Pregnancy * Prisoner