The course of treatment for angina will depend on the physician's determination of its severity and the extent of underlying cardiovascular damage. The patient's family medical history, particularly for heart disease, will also play a role in planning treatment.

For most patients with mild, stable angina, a combination of medications and risk-reducing lifestyle changes is usually recommended. Lifestyle changes include:

Medications used to treat angina either increase the supply of oxygen to the heart muscle or reduce the heart's need for oxygen. These medications include:

• Nitrates (e.g., nitroglycerin) widen, or dilate, the walls of the blood vessels. These drugs allow more blood, and therefore oxygen, to reach the heart, thus lessening the pain associated with angina attacks. Nitrates can be taken during an angina attack and may rapidly provide relief of symptoms, or they can be administered as daily medications for long-term control. In cases of persistent anginal episodes, nitroglycerin can be added to other medications, such as beta blockers or calcium channel blockers.
  
  
• Beta blockers slow the heart's resting rate and reduce the force of the accompanying heart muscle contraction, thus lessening the heart’s workload.
  
  
• Calcium channel blockers (calcium antagonists) block the entry of calcium into the cells, thus reducing the amount of calcium. This widens (dilates) the coronary arteries and increases the heart's blood flow. This class of drugs can also be used to treat coronary artery spasms associated with variant or Prinzmetal angina.
  
  
• Antiplatelet medications inhibit the formation of blood clots by decreasing the ability of platelets (the body's natural blood-clotters) to bind together and form blood clots. These drugs are typically not prescribed to reduce angina, but to reduce the risk of heart attack associated with coronary artery disease, of which angina is a major symptom. Aspirin is the most common antiplatelet. A second novel therapy is the combination of aspirin and another antiplatelet, clopidogrel (Plavix). Recent data suggest that these two drugs produce an enhanced, additive effect in reducing the risk of embolism and other adverse events after an episode of unstable angina. Positive results are also being seen with combined aspirin and clopidogrel in coronary stenting.
  
  
• Anticoagulant medications inhibit the formation of blood clots by inhibiting any of a number of coagulation factors. These drugs are typically administered to people who are at high risk of blood clots causing a heart attack or stroke. Anticoagulants, commonly called "blood thinners," must be closely monitored to make sure there is not increased risk of bleeding.

Individuals are encouraged to discuss with their physician any other medications or supplements they may be taking. For example, if a patient takes medication for erectile dysfunction in combination with nitrates it can provoke a dangerous drop in blood pressure.

In 2006 the U.S. Food and Drug Administration approved ranolazine (Ranexa), a treatment for chronic angina. Studies have shown that ranolazine is effective among patients with stable angina, but because it alters the heart rhythm, as a treatment for angina it is generally recommended only for patients who have failed other therapies.

For most patients with more serious or worsening angina, especially those in whom significant damage has already been found, further procedures may be performed, including:

• Angioplasty is a procedure in which a balloon–tipped catheter is inserted into a partially blocked coronary artery and rapidly inflated. The balloon compresses the plaque, pushing it against the artery wall, to allow for freer blood flow. Angioplasty is often followed by the insertion of a stent.
  
  
• Stenting is a procedure in which a small wire mesh tube called a stent is placed into a damaged artery via a catheter, usually at the same time an angioplasty is performed, to support and stretch the artery walls and provide for unrestricted blood flow. The development of drug-coated (drug-eluting) stents has helped to reduce the rates of re-narrowing (restenosis) after stenting and angioplasty. However, some recent data have implicated drug-eluting stents with increased long-term risk of blood clots, and researchers are studying the best application of stents.
  
  
• Atherectomy is a procedure in which a special catheter equipped with a grinding burr or blade is used to cut away plaque in the arteries. The plaque is then removed when the catheter is withdrawn from the artery, or the tiny pieces are absorbed into the bloodstream. This procedure is generally reserved for a small subset of patients because of the higher risks associated with the techniques.

• Coronary artery bypass grafting (CABG) is major surgery that relies on grafts created from the patient's own veins and arteries from elsewhere in the body (such as the internal mammary artery in the chest) to reroute the flow of blood around a blocked area of a coronary artery. Coronary artery bypass surgery may be performed with or without the heart-lung machine. If it is performed without the heart-lung machine, it is known as off-pump coronary artery bypass (OPCAB).
  
  
• Minimally invasive direct coronary artery bypass (e.g., MIDCAB) is a newer, less invasive form of coronary artery bypass surgery. In this procedure, the physician operates through smaller, keyhole incisions in the patient's side. It may be performed with or without use of the heart–lung machine. Because of the limited operating field, it is usually reserved for patients with more limited coronary artery disease and is often performed in conjunction with angioplasty.
  
  
• Transmyocardial revascularization (TMR), also known as transmyocardial laser revascularization (TMLR), is a newer surgical procedure in which a laser beam is used to make small holes in the heart to improve oxygenation to the heart muscle. This results in less chest pain.
  
  TMR may be an option for patients with severe angina that does not respond to medication. Earlier recommendations also reserved TMR for those not candidates for CABG or angioplasty. However, recent studies have shown benefit with CABG plus TMR, and even TMR with off-pump coronary artery bypass. When performed with bypass surgery, TMR may speed postoperative recovery and improve survival. TMR is not recommended for those with a low ejection fraction or heart failure.
  
  A variation of TMR is called percutaneous myocardial revascularization (PMR), in which the laser is delivered through an artery via a catheter until it is arrives at the heart. Also known as percutaneous transmyocardial laser revascularization (PTMR), this procedure has shown to improve exercise tolerance and relief from angina pain. However, the medical community has only limited experience with this method.
  
  
• External counterpulsation (ECP or EECP) is a newer, noninvasive technique that may be considered for individuals having stable angina but not eligible for conventional revascularization techniques. EECP uses blood pressure cuffs wrapped around the legs. As they are inflated and deflated, blood is pushed into the heart, improving circulation and reducing the heart's workload. Though this technique does appear to give some patients clinical improvement, it has a limited application and has not been generally accepted.

After surgery, medications such as anti-clotting agents and/or antioxidants (both vitamins and drugs) may help to prevent re-blockage of the arteries (restenosis).

Physicians continue to debate whether medication or surgery is preferred for stable angina. In 2007 a major trial called the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) showed that drug therapy lowered patients' risk of heart attack and death. However, some physicians found that the data supported angioplasty as a first-line treatment. Angina may be treated case by case rather than according to one specific protocol because of the wide range of factors such as the patient's overall health, lifestyle and degree of atherosclerosis.