Although there are opinions to the contrary, the literature provides fairly convincing evidence that some psychodynamic features are more frequent than others in subjects prone to coronary heart disease. As personality changes often take place following myocardial infarction, retrospective studies are less convincing than prospective ones. Most of the latter are rather superficial in nature. However, they point in the direction of predominance of obsessive-compulsive character defences, more in myocardial infarction than in angina pectoris without myocardial infarction. Poverty of fantasy life, operational mode of mental functioning (‘pensée opératoire’ of the French school), repression and control of emotional reactions appear predominantly in the former.