Proximal femur fractures are amongst the most common fractures in elderly people. As elderly patients present with multiple comorbidities including cardiac dysfunction, the anesthesia management in such cases can be quite challenging. We present a case report describing the successful anesthetic management of an elderly patient with severe systolic dysfunction posted for proximal fracture femur fixation. The importance of alternative anesthetic options to Sub-Arachnoid Block, especially Regional Anesthetic techniques, in elderly patients with left ventricular dysfunction, is emphasized.