The goals of preoperative assessment of patients are to reduce the morbidity of surgery, to increase quality but decrease the cost of preoperative care and to return the patient to desirable functioning as quickly as possible. As many as one third of surgical patients have significant coronary artery disease so the initial history, physical examination and electro cardio gram should focus on identification of potentially serious cardiac disorders including coronary artery disease, heart failure, symptomatic arrhythmias, presence of pacemaker or history of orthostatic intolerance.