Stress echocardiography has emerged as a valuable technique for the noninvasive detection of coronary artery disease. The accuracy of exercise echocardiography, using treadmill or bicycle stress, and of pharmacological stress echocardiography, using dobutamine or vasodilators, has been verified in large numbers of patients. In the detection of coronary artery disease, its accuracy is superior to that of the exercise electrocardiogram and appears comparable to the accuracy of SPECT perfusion imaging. In addition, stress echocardiography is useful in the localization and quantitation of coronary artery disease. Unique to stress echocardiography is the potential to detect other forms of heart disease that may be associated with chest pain. These characteristics support its use in the evaluation of the patient with chest pain.