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Comorbid cardiovascular diseases can significantly increase the risk for perioperative morbidity and mortality. Increasing age of surgical populations and increasing invasiveness of surgical procedures further contribute to a significantly increased perioperative cardiovascular complication rate. Treatment of cardiovascular comorbidities and prevention of cardiovascular complications can decrease the perioperative risk. For detection and treatment of cardiovascular risk patients a thorough understanding of the underlying pathophysiology is of utmost importance. This article therefore reviews clinically relevant features of cardiovascular diseases with an emphasis on coronary artery disease and heart failure.