Patients with a history of heart failure who undergo non-cardiac surgery under general anaesthesia are at increased risk of perioperative cardiac complications. Heart failure is a common problem in Bangladesh and due to some relative contraindication: general anaesthesia is used for this associated disease. This study corellates with the study of Sock Huang Koh et al and V Karapandzic et al. To ensure adequate oxygenation with easy maintenance of cardiac parameters and for good outcome, General anaesthesia is selected for this patient. The anaesthetic management of a patient with heart failure non-cardiac surgery is all ways a challence to the anaesthesiologist, yet we do it successfully without invasive monitoring

General anaesthesia, Patey's mastectomy, Heart failure

Heart failure describes the clinical syndrome that develops when the heart can not maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure. Heart failure is frequently due to coronary artery disease, tends to affect elderly people and often leads to prolong disability. Significant heart disease develops the signs or symptoms of a low cardiac out, pulmonary congestion or systemic venous congestion. In mild to moderate forms of heart failure, cardiac output is adequate at rest and become inadequate when the metabolic demand increases during exercise or some other form of stress such as General anaesthesia1. It occurs in 1- 2% of the population, rising to in the over 75 year of old age group, and is associated with increased mortality following anaesthesia. The commonest cause is ischemic heart disease. Other causes include hypertension, valvular heart disease and cardiomyopathies. One third of untreated patients with an ejection fraction of less than 40% will die within a year?