Bicycle stress echocardiography involves the recording and interpretation of two-dimensional echocardiographic information before, during, and after bicycle exercise. The exercise test can be performed in the supine or upright posture. While there are important physiological differences between these two positions, they appear to provide similar diagnostic information on the presence or absence of coronary artery disease. A major advantage of bicycle stress echocardiography compared to treadmill exercise is the ability to image at peak exercise, rather than relying solely on pre- and postexercise imaging. This contributes to the greater sensitivity of the test for the detection of ischemia. The recent application of digital processing techniques may also improve sensitivity by permitting side-by-side comparison of rest and stress images. In summary, bicycle stress echocardiography is a useful tool in the management of patients with known or suspected coronary artery disease. It is a versatile and accurate technique, which competes favorably with other imaging modalities and provides information on regional and global left ventricular function.