This review discusses what cardiac investigations and interventions are indicated before surgery. There are three questions, the answers to which will usually determine the necessity for further preoperative cardiac testing in elective surgery. 1) Does the patient have poor exercise tolerance? 2) Does the patient have two or more unoptimized risk factors for coronary artery disease? 3) Is the surgery high risk? If the answer to two or more of these questions is yes, then further cardiac testing is appropriate. If none or only one is positive, further testing can be postponed until after surgery. This is especially true if beta blockers or other cardioprotective medications are prescribed. The evidence that perioperative beta blockers reduce perioperative risk is not appearing to be as strong as initially presented. Beta blockers should be used where indicated whether or not surgery in planned, and above all, must not be stopped.