The atherosclerotic disease takes changes in the structure of arterial vessels derived by aging and undesirable effects of fat metabolism with the interplay of thrombocites and intrinsic humoral response. The pyramid of atherosclerotic disease can be detected at different stages and with different ultrasound tools. Stress echocardiography detects the tip of the atherosclerotic iceberg, i.e., the hemodynamically significant, ischemia-producing coronary artery stenosis through unmasking of stress-induced regional ventricular dysfunction.
In that manner, stress echocardiography can contribute as complementary to coronarography finding, by defining more closely coronary flow reserve and myocardial function at regional level (in segmental heart model).

Pharmacological testing of myocardial function

In those we mention: dobutamine, dipyridamole, adenosine, and their combination with atropine. These are tests of coronary flow reserve and  viability.

Coronarography

Invasive diagnostic procedure of coronary vessels with intravenously given contrast soluble, to acquire different extent narrowing and even no flow through them. Also, this method allows measuring of pressure curves in different chambers and valves, as well as concentration of oxygen present (in congenital heart disease). This is very low risk procedure, and is enormously valuable in treatment decision making (stent or bypass surgery).

Electrophysiological study- EP study

EP study is another invasive diagnostic procedure performed by low frequency electrical stimulation in order to provoke electrical instability with the aim to exam conduction system in heart. It is done by few experts in this field, and is definite in diagnostic and prognostic outcome (pace maker implantation).
Most importantly, during EP study some severe arrhythmias (that lower the quality of life) can be solved permanently.