Abstract
Heart failure poses significant challenges in perioperative settings, with an increasing prevalence in India. While much attention has been given to the management of symptomatic heart failure, there is a dearth of literature on asymptomatic left ventricular systolic dysfunction (ALVSD). In this case report, we present the successful perioperative management of a 35-year-old male with ALVSD and a low ejection fraction undergoing lower limb surgery under combined spinal epidural anesthesia. Our approach aimed to maintain hemodynamic stability, minimize myocardial overload, and mitigate the adverse effects of neuraxial blockade.