As improvements in therapy have extended the survival rate of patients with ischemic heart disease, increasing attention to the quality of survival has resulted in an appreciation of the profound effect of psychologic factors on the patient's life. A multidisciplinary approach, including evaluation and management of pertient psychologic factors, should be part of the treatment of all patients with coronary heart disease. Ischemic heart disease often requires both patient and family to make difficult changes in personality and life-style. As soon as the physiologic stress begins to subside, the physician should begin to provide sympathetic, specific guidelines toward acceptance of the disease and accommodation to its limits. Potential problems and their management are discussed within the framework of the three stages of chronic illness.