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.