Transthoracic echocardiography has become increasingly popular in clinical practice. It is used for the functional evaluation of patients with various cardiovascular diseases. Its use has been extended further in routine screening for cardiovascular health and in preoperative risk assessment before non-cardiac surgery because it is non-invasive, easy to perform, reproducible, and cost-effective. When the results of preoperative echocardiography contain abnormalities, the findings must be interpreted to determine clinical relevance. However, when the results of preoperative echocardiography are apparently normal, many physicians and surgeons readily think that the patient will not have any cardiovascular events in the future, or at least in the perioperative period. In this review, we will cover 1) current guidelines for preoperative echocardiographic assessment, 2) specific cardiac conditions for which the non-cardiac surgery should be delayed, 3) commonly encountered echocardiographic findings before non-cardiac surgeries, 4) application of stress echocardiography, and 5) clinical perspectives of focused transthoracic echocardiography before non-cardiac surgery.