After ten years of life restricted to the scientific world of research, stress echocardiography today appears on the clinical stage as a clean and efficient option for diagnostic imaging of myocardial ischemia. At the Institute of Clinical Physiology of Pisa, stress echocardiography has successfully moved from the status of fancy pathophysiological toy to one of practical diagnostic weapon – in spite of the availability of a strong and sophisticated nuclear cardiology department. This textbook stems from a long-standing experience and describes in a systematic fashion the new diagnostic entity of stress echocardiography: the pathophysiological and experimental roots, the methodology, the clinical fruits and the new branches of possible future development. Only time will tell whether the new plant of the diagnostic forest will grow tall; but certainly its place is no longer in the academic greenhouse with exotic entities, but rather in the open air of the real world, where this baedeker might be of help to the clinician and the researcher interested in ischemic heart disease.