Prognosis of severe ischemic heart disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting remains poor. Extracorporeal shock wave (SW) therapy was introduced for medical therapy more than 20 years ago to break up kidney stones. We have demonstrated that extracorporeal cardiac SW therapy at a low level (about 10% of the energy density that used for urinary lithotripsy), effectively induces coronary angiogenesis and improves myocardial ischemia in a porcine model of chronic myocardial ischemia in vivo. Also, our extracorporeal cardiac SW therapy improved symptoms and myocardial ischemia in patients with severe coronary artery disease. Importantly, no procedural complications or adverse effects were noted. These results indicate that our extracorporeal cardiac SW therapy is an effective and non-invasive treatment for ischemic heart disease.