Angina continues to be a leading cause of morbidity and mortality in the Western world. While the clinical identification of angina occurred over two centuries ago, our understanding of the pathophysiology of the anginal syndromes continues to increase rapidly, as does our understanding of the triggers of angina and its prognosis. These insights have allowed us to tailor therapy and diagnostic strategy more accurately to reverse the pathophysiological defect. As our understanding grows, our ability to prevent the deleterious outcomes associated with angina will increase.