Improved pharmacological, invasive, and surgical therapies for cardiovascular diseases over the last few decades have led to an increase in life expectancy of individuals with angina. Despite treatment with multiple medications and invasive procedures, these patients remain symptomatic and functionally limited. Enhanced external counterpulsation (EECP) is a safe, noninvasive, well-tolerated, and clinically effective outpatient physical therapy for many patients with refractory angina. Numerous trials demonstrate positive clinical responses to EECP, including reductions in angina and nitrate use, increase in exercise tolerance, and enhanced quality of life. Several mechanisms are thought responsible for the clinical benefits of this therapy. Despite the marked success rates EECP achieves, the treatment remains largely unknown. This review will summarize the current evidence for the use of EECP and spark a better understanding of the potential role of this treatment.