Exercise electrocardiography positivity at intermediate to high load, as well as negativity at a submaximal workload, or negativity in the presence of chest pain, warrants a stress echocardiography test. The latter should establish the diagnosis of ischemia with a higher reliability and should define its extent and severity. Stress echocardiography test negativity makes the presence of a prognostically important organic coronary disease unlikely. The excellent outcome associated with this response does not support the decision to proceed with coronary angiography. The stress echocardiography test positivity identifies a group of patients at higher risk in whom coronary angiography is warranted. However, stress echocardiography positivity should be titrated, since the associated risk may range anywhere between 2% and 20% mortality per year, depending on the time, space, extent, severity, recovery of inducible wall motion abnormalities, and concomitant therapy at the time of testing. It is important to choose the right stress echocardiography test for the right patient. Exercise echocardiography can, and should, be the first-line test, skipping the exercise electrocardiography test, in patients with conditions making ECG uninterpretable, such as left bundle branch block or Wolff-Parkinson-White syndrome or baseline ST segment abnormalities. Instead of pharmacological stress echocardiography, it may be wise to choose exercise echocardiography also in patients with an ambiguous positive result during an exercise electrocardiographic test at a workload of 6 min or less. This kind of patient (typically, a middle-aged hypertensive woman with ST-segment depression at a peak rate pressure product below 20,000) can have either angiographically normal or severely diseased coronary arteries. Exercise also has the advantage of being the safest test.