The 2014 ESC/ESA guidelines on noncardiac surgery provide step-by-step guidance for managing cardiac patients undergoing noncardiac surgery. Key updates include the recommendation of a multidisciplinary team for high-risk patients, updated surgical risk assessment, use of the Lee score and other validated risk scores, revised risk reduction strategies, updated recommendations on aspirin and P2Y12 inhibitors, and new oral anticoagulants. The guidelines also address the timing of surgery in patients with recent revascularization, specific disease conditions, and perioperative monitoring. The approach emphasizes evidence-based recommendations and cautious use of expensive imaging techniques. Clinical risk factors include ischemic heart disease, heart failure, stroke, renal dysfunction, and diabetes. Preoperative assessment includes 12-lead ECG, echocardiography, and stress testing for high-risk patients. Noninvasive imaging techniques like stress echocardiography and nuclear MPI are used for risk stratification, though their use is restricted to cases where results may influence management. Invasive coronary angiography is recommended in specific cases, such as acute coronary syndromes or hemodynamically unstable patients. Overall, the guidelines advocate for a conservative use of advanced imaging and stress tests, emphasizing the need for further research in this area.The 2014 ESC/ESA guidelines on noncardiac surgery provide step-by-step guidance for managing cardiac patients undergoing noncardiac surgery. Key updates include the recommendation of a multidisciplinary team for high-risk patients, updated surgical risk assessment, use of the Lee score and other validated risk scores, revised risk reduction strategies, updated recommendations on aspirin and P2Y12 inhibitors, and new oral anticoagulants. The guidelines also address the timing of surgery in patients with recent revascularization, specific disease conditions, and perioperative monitoring. The approach emphasizes evidence-based recommendations and cautious use of expensive imaging techniques. Clinical risk factors include ischemic heart disease, heart failure, stroke, renal dysfunction, and diabetes. Preoperative assessment includes 12-lead ECG, echocardiography, and stress testing for high-risk patients. Noninvasive imaging techniques like stress echocardiography and nuclear MPI are used for risk stratification, though their use is restricted to cases where results may influence management. Invasive coronary angiography is recommended in specific cases, such as acute coronary syndromes or hemodynamically unstable patients. Overall, the guidelines advocate for a conservative use of advanced imaging and stress tests, emphasizing the need for further research in this area.