Stress echocardiography is accepted as a routine test in patients with coronary artery disease for the identification of myocardial ischaemia, the diagnosis of viable myocardium and assessment of prognosis. This review addresses the application of the test to non-coronary heart diseases. Some caution should be applied to the use of stress echocardiography for the detection of ischaemia in patients with valvular heart disease. However, examination of haemodynamics and left ventricular function during exercise is worthwhile in the assessment of symptomatic patients with apparently mild or moderate valvular disease, as well as being useful for the detection of subclinical left ventricular dysfunction. In the future, this tool may be more widely applied to the identification of other 'subclinical' conditions, including pulmonary hypertension, anthracycline cardiotoxicity and valvular heart diseases, although the benefit of early diagnosis of these conditions remains to be established.