Despite existing recommendations, a standardized perioperative approach for patients with heart failure remains undetermined. These patients face increased morbidity and mortality in both cardiac and noncardiac surgeries, necessitating meticulous medication management to mitigate risks of hypoperfusion, arrhythmias, and renal dysfunction. The perioperative use of ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), loop diuretics, and sodium-glucose cotransporter-2 (SGLT2) inhibitors requires careful consideration. Elective surgeries should be deferred in patients with acute heart failure symptoms, hemodynamic instability, or suboptimal medical management. Advanced hemodynamic monitoring, including pulmonary artery catheters and arterial lines, should be considered, particularly for high-risk cases. The use of inotropes, inodilators, vasoconstrictors, and mechanical circulatory support may be necessary to maintain stability during surgery. Biomarkers such as high-sensitivity troponin (hs-cTn) and B-type natriuretic peptide (BNP/NT-proBNP) are valuable tools for preoperative risk stratification, helping guide perioperative decision-making and improve outcomes.