Cardiac complications remain a leading cause of perioperative morbidity and mortality, particularly in high-risk surgical populations. The postoperative period is characterized by significant physiological stress, residual anesthetic effects, fluid shifts, pain, and inflammatory responses to surgery, all of which can destabilize the cardiovascular system. Myocardial infarction, arrhythmias, heart failure, and tamponade represent critical complications that demand prompt recognition, urgent stabilization, and early multidisciplinary involvement, particularly cardiology and cardiac surgery when appropriate. Diagnosis and treatment are uniquely challenging in the postoperative context. Symptoms such as chest pain may be absent or masked by analgesia or sedation. Electrocardiogram (ECG) changes may be subtle, and troponin elevations may overlap with perioperative myocardial injury unrelated to infarction. Arrhythmias often stem from electrolyte abnormalities, catecholamine surges, or hypoxemia. Heart failure may result from perioperative fluid overload, transfusion-related effects, or exacerbation of underlying ventricular dysfunction. Tamponade, while less common, is a life-threatening emergency, typically occurring after cardiac or thoracic procedures, but can also occur following central line placement. Management must balance standard principles with surgical considerations, including recent incisions, risk of bleeding, need for reoperation, and restrictions on antiplatelet or anticoagulant therapy. Across all these scenarios, timely consultation with cardiology and, for surgical complications such as tamponade, cardiac surgery is critical for optimal outcomes.