Chronic angina is a prevalent manifestation of cardiovascular disease and is most commonly due to insufficient oxygen supply from fixed epicardial lesions in the coronary arteries. In addition to increasing the risk of cardiovascular death and recurrent myocardial infarction, chronic angina has a significant impact on functional capacity and quality of life. All patients with cardiovascular disease should be closely questioned to determine the functional and symptomatic limitations attributable to ischemic symptoms. The Canadian Cardiovascular Society Classification of Angina is the easiest metric to use; however, more sensitive measures such as the Seattle Angina Questionnaire offer a better overall assessment of angina symptoms and quality of life and can be used to compare the efficacy of different treatments. Treatment strategies that begin with either immediate revascularization or optimal medical therapy with antianginal agents significantly improve angina frequency and quality of life. Initial revascularization, especially with coronary artery bypass grafting, appears to offer more rapid relief of angina compared with percutaneous coronary intervention or medical therapy in the first months after initial revascularization. After a year of follow-up, though, much of the treatment differences are lost and all strategies (surgical/percutaneous revascularization or medical therapy) result in a significant improvement of angina symptoms.