The American College of Cardiology and the American Heart Association (ACC/AHA) have developed joint guidelines for the preoperative cardiovascular evaluation of patients undergoing noncardiac surgery. The initial evaluation consists of the patient's history, focused physical examination, and routine laboratory investigation. Based on the patient's history, cardiac risk factors, functional status, and the nature of the surgical procedure, the ACC/AHA guidelines provide a stepwise approach for identifying patients who may benefit from further cardiovascular testing (Fig. 2.2).