Cardiovascular comorbidities are amongst the most important modifiable risk factors in patients undergoing non-cardiac surgery. Likewise, cardiac complications are a leading cause of all perioperative morbidity and mortality. Major adverse events include acute myocardial ischaemia, infarction, congestive cardiac failure, arrhythmias, and cardiac arrest. Preoperative assessment and planning aims to minimize these risks. Although testing is important, it must be rationalized lest resources are misused and undue delays ensue. Current thinking in preoperative therapy, intraoperative management and postoperative care is discussed. Although most patients with cardiac disease have ischaemic heart disease, other specific cardiac conditions and principles of their management are briefly considered.