The 2014 European Society of Cardiology (ESC) and European Society of Anaesthesiology (ESA) guidelines on noncardiac surgery provide a comprehensive framework for managing cardiac patients undergoing such surgeries. The guidelines emphasize the importance of a multidisciplinary team approach and highlight specific clinical risk factors, including ischemic heart disease, heart failure, stroke, renal dysfunction, and diabetes mellitus. They recommend preoperative cardiovascular imaging and stress testing based on the patient's risk factors and physical capability. Noninvasive tests like 12-lead ECG, echocardiography, and stress echocardiography are indicated for patients with intermediate to high-risk surgery, while routine preoperative evaluation is not recommended. Invasive coronary angiography is reserved for specific high-risk cases, such as acute coronary syndromes or patients with signs of myocardial ischemia. The guidelines advocate a conservative use of advanced imaging techniques to ensure evidence-based and cost-effective management.The 2014 European Society of Cardiology (ESC) and European Society of Anaesthesiology (ESA) guidelines on noncardiac surgery provide a comprehensive framework for managing cardiac patients undergoing such surgeries. The guidelines emphasize the importance of a multidisciplinary team approach and highlight specific clinical risk factors, including ischemic heart disease, heart failure, stroke, renal dysfunction, and diabetes mellitus. They recommend preoperative cardiovascular imaging and stress testing based on the patient's risk factors and physical capability. Noninvasive tests like 12-lead ECG, echocardiography, and stress echocardiography are indicated for patients with intermediate to high-risk surgery, while routine preoperative evaluation is not recommended. Invasive coronary angiography is reserved for specific high-risk cases, such as acute coronary syndromes or patients with signs of myocardial ischemia. The guidelines advocate a conservative use of advanced imaging techniques to ensure evidence-based and cost-effective management.