Refractory Angina Pectoris is a chronic pain condition relating to myocardial ischaemia in the presence of coronary artery disease despite optimal medical therapy. It affects a cohort of patients with a subset of the coronary perfusion deficiencies. While there is no cure for these patients, an array of medical and interventional treatment is available in 2021. In this article we discuss the options available with an explanation of the mechanisms of action and evidence for their use.