Affective disorders cluster in patients with cardiac diseases, in particular in coronary artery disease (CAD) which has become one of the most prevalent chronic disorders in the western world. Affective dysregulation has been recognized as a major riskfactor for cardiac death in patients with CAD. Therefore treatment of affective dysregulation is important from both the psychiatric and cardiac perspective. An evidence based treatment algorithm for affective disorders is as yet not available. In this paper a possible etiological model for the relationship between affective and cardiac dysregulation is proposed, based on the stress-diathesis model.