The stress echo is performed to detect the conditions like false positive stress tests, left bundle branch block, Wolff-Parkinson-White, left ventricular strain pattern, angiographic borderline disease and so on. When stenotic epicardial coronary vessels have nearly exhausted, then the ischemia at this stage is detected by nuclear, gadolinium MRI, positron emission tomography (PET) and myocardial contrast perfusion scans. When more prolonged ischemia leads to segmental diastolic dysfunction, then this stage of ischemia is detected by visual assessment of wall motion, segmental systolic thickening on stress echo and stress MRI or can be quantified by tissue Doppler or 2D strain imaging. In this chapter various stressors used in stress echo (exercise, pharmacological stressor), interpretation of stressor echo, use of contrast, use of tissue Doppler, strain and 3D and myocardial viability by stress echo are all discussed in detail.