Although we recommend against routinely obtaining echocardiography before noncardiac surgery to enhance perioperative cardiac risk estimation, if a patient requires urgent/semiurgent or elective surgery and their clinical examination suggests the patient has an undiagnosed severe obstructive intracardiac abnormality (eg, aortic stenosis, mitral stenosis, hypertrophic obstructive cardiomyopathy) or severe pulmonary hypertension, then urgent echocardiography should be obtained before surgery to inform the anesthesiologist, surgeon, and medical team of the type and degree of disease. Moreover, if a physician’s clinical assessment suggests a patient might have an undiagnosed cardiomyopathy then echocardiography should be performed to facilitate optimization of long-term cardiac health. Physicians should consider the urgency of the surgery when deciding whether echocardiography is obtained before or after surgery.