Within the last decade of this millennium, stress echocardiography has been established for the diagnosis and follow-up of coronary artery disease. The basis is the technical development of the echo machines: first, the improved echocardiographic resolution and, second, the digital image storage of a whole cineloop, which may be interpreted frame-by-frame in an ECG synchronized manner for several exercise levels simultaneously. Myocardial ischemia can be detected much earlier by regional contraction abnormalities of the left ventricular myocardium than in conventional ECG exercise tolerance testing explaining the higher sensitivities. Furthermore, the extent and localization, including the correlation with the stenotic coronary anatomy, is possible. The usage of pharmacological stress agents (dobutamine, arbutamine, dipyridamole, adenosine) or electrical stimulating methods (transesophageal, intracardial) allow the examination of patients unable to exercise in similar accuracy.