The combination of surgery and heart disease is common. The incidence of both heart disease and surgery increase with the age of patients. However, the surgical risk in the cardiac patient and particularly in the coronary or heart failure patient is considerably aggravated. Surgery is a major factor in cardiac decompensation, which can accelerate the progress of the disease. Pre-anesthetic cardiological consultation is therefore an important part of the evaluation and preparation of the patient before surgery. This is carried out at the request of the anesthetist and can provide a diagnosis or adapt a treatment and above all define the cardiovascular competence of the patient. Diagnostic and therapeutic means available to the cardiologist are essential in defining and if possible reducing the cardiac handicap of patients before the hemodynamic challenge represented by the combination of anesthesia and surgery.