Adenosine is a naturally occurring vasodilator which has been used for the induction of maximal coronary hyperaemia in the cardiac catheterization laboratory and in conjunction with myocardial perfusion scintigraphy. Its use as a stress agent with echocardiography is dependent upon the development of coronary steal. The sensitivity of adenosine stress echocardiography has been reported to be quite variable, depending on the nature of the population studied. However, in individuals without previous myocardial infarction, the test has a poor sensitivity, particularly in patients with single vessel coronary disease. Moreover, although the agent is safe, troublesome side effects are frequent. The combination of lower sensitivity than competing techniques, side effects, and cost do not favour the combination of adenosine stress with echocardiography.