Although infrequent, perioperative cardiac complications are a source of major morbidity and mortality. As the population ages, the prevalence of cardiovascular disease is increasing. For physicians who refer patients for surgery as well as for clinicians directly involved in perioperative medical care, an understanding of perioperative cardiac complications, reduction of such complications, and treatment of complications are essential. This article summarizes the approach to perioperative hypertension, hypotension, myocardial ischemia, myocardial infarction (MI), and congestive heart failure (CHF). The reader is referred to the article by Sloan in this issue for a discussion of the approach to perioperative cardiac arrhythmias.