It is challenging to administer anaesthesia in patients with pre–existing heart conditions. Now a days number of patients presenting for surgery with heart conditions are in rising trend and it may be due to increased life span and better anaesthetic techniques available and their increased safety. Ejection fraction (EF) is important in diagnosing and tracking the heart failure as it shows how well the heart is pumping out blood. Patients with EF < 30% ( Low EF ) are at risk of arrhythmias leading to sudden cardiac arrest and death. Goals for management of these patients include promoting adequate heart rate, maintaining adequate cardiac output, avoidance of arrhythmias. Care of these patients include proper identification of risk factors, pre­–anaesthetic evaluation, vigilant monitoring of patient both intra operatively and post operatively and appropriate use of drugs. Here we present a case of 58 year old man with previous history of cardiac stenting,taking various cardiac drugs and having EF of 20%, who successfully underwent right sided inguinal hernia repair under unilateral spinal anaesthesia.