Summary Coronary heart disease is the major cause of death worldwide and is affecting millions of people in both developed and developing countries. Patients with myocardial ischemia typically experience chest pain (angina pectoris). Traditional viewpoint of ischemic cardiac pain might be related to “mechanical hypothesis” in early time and “chemical hypothesis” in modern time. However, perception of cardiac ischemic pain is still not well understood. The previous studies suggested that neurogenic mechanisms including neurogenic inflammation and neurogenic activity might participate in the pathophysiological processes following myocardial ischemia. Therefore, we raise “neurogenic hypothesis”, that is, neurogenic mechanisms might play a pivotal role in myocardial ischemic injury. Analgesia intervention, rivalry of neurogenic inflammatory reactions and electrostimulatory therapy, etc. could not only relieve the pain symptoms, but also block nociception of body and neurogenic reaction induced by ischemia. Thereby ischemic myocardial injury would be extenuated and myocardial protection be produced. Attempts to confirm this hypothesis may lead to new theory of pathophysiologic mechanisms and provide potential intervention strategy for cardiac ischemic pain.