Summary Preoperative evaluation of patients with increased cardiac or pulmonary risk requires precise knowledge regarding the underlying pathophysiology of the disease as well as the specific impli­cations concerning perioperative treat­‑ment of the patient. Apart from the standard procedures (anamnesis and physical examination), decisions as to whether additional examinations are required must be made on the basis of the pathology of the disease, the risks of surgery and existing co-morbidities. The European Society of Anaesthesiology recently recommended that a preoperative risk evaluation should be performed by an integrated multidisciplinary team which should include anaesthesiologists, cardiologists and surgeons, and, whenever appropriate, an extended team. Furthermore, these guidelines give re­commendations for the application of various examination methods to patients with a cardiac risk. For patients with an increased pulmonary risk, numerous vali­‑dated scoring systems are available for a preoperative risk assessment. The appli­‑cation of these scoring systems facilitates risk stratification and provides rationales for the indication of additional analyses. Additional risks must be considered in case of patients with morbid obesity.