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A clinical practice guideline issued by the American College of Cardiology and American Heart Association, published in both Circulation and the Journal of the American College of Cardiology, presented updated recommendations for the perioperative cardiovascular management of non-cardiac surgery. A stepwise approach to perioperative cardiac assessment can help clinicians determine whether surgery should proceed or a pause for additional evaluation is necessary. For patients undergoing non-cardiac surgery, cardiovascular screening and treatment should adhere to the same indications as for non-surgical patients, with careful timing to avoid surgery delays. Stress testing should be performed judiciously, especially for those at lower risk and only in appropriate patients, regardless of planned surgery. Myocardial injury after non-cardiac surgery is a newly identified disease process that should not be ignored. The risk for stroke is greater for patients with newly diagnosed atrial fibrillation identified during or after non-cardiac surgery. Only patients at the highest risk for thrombotic complications should use perioperative bridging of oral anticoagulant therapy.