In session one anesthetic management for a patient with hypertension and session two anesthetic management for anemic patient, we have looked important points to administer anesthesia for these specific problems. This session is complementary to session one and two, anesthesia management for a patient with very common cardiac problem. Myocardial ischemia, interruption of blood supply to the part of the heart, may exist in surgical patient preoperatively secondary from hypertension, diabetes mellitus, anemia and other cardio respiratory problem. The problem may develop perioperatively in relatively healthy patient from faulty anesthetic technique or exacerbating the preexisting problem, which both can produce temporary or permanent heart and other organ system problem. Patients with congestive heart failure and myocardial ischemia shall be definitely managed in a resourceful hospitals and where high level anesthesia professional/ Anesthesiologist is available. The purpose of this presentation is to introduce this common coexisting problem and provide anesthetic management in emergency and in situation when patient could not be referred. In this session you will learn to acquire, knowledge, skill and right attitude in managing surgical patient with ischemic heart disease and heart failure.