J Am Acad Orthop Surg, Vol 18, No 5 Robert C. Decker, MD, Jennifer R. Foley, MD and Thomas J. Moore, MD Dr. Moore or an immediate family member is a member of a speakers bureau or has made paid presentations on behalf of Osteotech and Synthes, serves as an unpaid consultant to Osteotech, and has received research or institutional support from Synthes. Neither of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Decker and Dr. Foley. The overall incidence of perioperative death is relatively low. However, patients with coronary artery disease are at higher than average risk of perioperative cardiac complications. Thus, preoperative testing for cardiac disease should be done in certain patients in an effort to reduce postoperative mortality and morbidity. Patients who require emergent orthopaedic surgery are at greater risk of perioperative cardiac events than are those who undergo elective procedures. Certain modalities, such as beta blockers, statins, and alpha-2 agonists, may be started or continued in the postoperative period to further enhance cardiac function. We review the current recommendations for preoperative cardiac testing in orthopaedic patients and for perioperative management of orthopaedic patients with known cardiac disease.