Internists are frequently consulted to perform preoperative risk assessments on patient undergoing non-cardiac surgery. Physicians need to assess the cardiac risk associated with the surgery, identify the patient's unique risk profile, recommend appropriate preoperative testing and make suitable recommendations. By a focused history-taking, physical examination, and application of current evidence-based guidelines in cardiac risk assessments, patients at high risk for complications at surgery can be identified and additional work-up suggested. Effective preoperative recommendation includes an assessment of risk (cardiac and non-cardiac), recommendations on medication adjustment, thrombo-embolic prophylaxis, and use of perioperative beta blockers. Prompt communication with the surgeon often enhances the quality of medical consultation and ensures compliance.