Clinical state of the patient and the type of surgery must by taken into consideration in the assessment of preoperative cardiac risk in patients with ischaemic heart disease prior to noncardiac surgery. Preoperative evaluation should be based on aimed clinical examination, functional capacity and electrocardiogram assessment. Other specialized examinations are only selective. The degree of haemodynamic load of the patient and the urgency of surgery are significant in the characteristics of the surgery. High risk patients with unstable coronary syndromes, congestive heart failure or severe arrhythmias require delay of elective surgery and further specialized examinations and treatment. Beta-blockers are preferred in preoperative and perioperative care of patients with ischaemic heart disease. Electrocardiographic monitoring, pain management and low-dose heparin are recommended in perioperative care. For patients, who experience perioperative myocardial infarction, percutaneous coronary intervention should be considered after the risk versus benefit has been weighed.