OBJECTIVES: Successful perioperative management of patients with previous ishchaemic heart disease undergoing non cardiac surgeries required careful teamwork, communication with patient, physician and surgeon.

METHODS: We present a case of 28 yr old male patient undergoing an elective orthopedic procedure with previous history of acute coronary syndrome (anterior wall myocardial infarction), recanalised with inj. Streptokinase and later started on dual antiplatelet agents ( Warfarin and Clopidogrel)

RESULTS: Regional anaesthetic technique with subarachnoid block with reasonably low level block was done with judicious use of drugs and fluids and avoiding tachycardia.

CONCLUSION: Preoperative assessment of PT - INR were done after starting inj. Heparin perioperatively to avoid bleeding during surgery and ata the same time controlling the risk of an acute attack of ischaemia is the main aim of anaesthetic management. Monitoring cardiovascular dynamics along with adequate intraoperative Oxygen delivery and fluid management plays a vital role in managing such cases.