Chronic angina that is refractory to medication and conventional revascularization is a growing clinical problem. Several approaches are in use in treating these “heart sink” patients and range from doing nothing through extremely low-cost and low-risk treatments to high-cost and high-risk procedures. The UK National Refractory Angina Consensus Guideline sets out a logical order in which these therapies should be tried based on the available evidence. There is no doubt that these complex patients and their families are best managed within a patient-centered multidisciplinary framework, and perhaps it is time to consider a new subspecialty that embraces the best of cardiology, pain management, and psychology...