The sixth edition of Ellestad's classic text on cardiac stress testing has been extensively updated and re-written to communicate contemporary understanding of the classical principles of stress testing to clinicians and researchers, students and seasoned practitioners alike. The current techniques for performing stress tests presented herein reflect major technologic advances in imaging, physiologic monitoring and the assessment of cardiovascular risk, addressing fundamental paradigm shifts in interventional, surgical and medical treatment of heart disease. Moreover, the text addresses the dramatic changes that are occurring in patient demographics and the environmental, socioeconomic, gender and genomic factors that crucially impact heart disease and warrant attention when performing cardiac stress testing. Chapters on the physiology of exercise testing including practical details regarding protocols for conducting the stress test, proper supervision, important parameters to be monitored, and the diagnostic and prognostic information to be gleaned from the electrocardiogram set the stage for expanded chapters on the use of cardiac imaging in conjunction with stress testing. Physiologic and metabolic considerations during stress testing are covered in detail. Application of stress testing to special populations, such as women, children, athletes, and individuals in both high and low risk groups are covered in new chapters. Finally, the authors address the use of stress testing in limited resource environments and discuss global changes in the incidence of atherosclerosis, and suggest how stress testing may evolve.