Many patients will have elevated operative risk given cardiac history, and this has implications both in the preoperative and postoperative setting. Risk factors include hypertension, diabetes mellitus, angina, vascular disease, family history of coronary artery disease, and history of tobacco use. The Revised Cardiac Risk Index (RCRI) tool is the most commonly used index to determine a patient’s preoperative cardiac risk. Anticipating and appropriately managing both preoperative and postoperative issues are key. The exam questions asked are to show that the surgeon knows how to manage an urgent or emergent surgical patient who has a history of a recent myocardial infarction (MI). As the question continues, the scenario may develop into an intraoperative or postoperative MI. This should not necessarily be seen as a failure, but managed as part of the overall question.