Psychiatric disease, particularly depression and stress disorders, worsen the outcome of cardi-ovascular disease substantially. Although this mind-heart interaction is known since the 1930s, many questions with regard to the underlying pathophysiology remain to be answered. Apart from psychological stress and psychiatric disease, inflammatory or psychoimmunology processes, metabolic or endocrinological mechanisms may be involved as are lifestyle and effects of drug treatment. The takotsubo or broken heart cardiomyopathy, which can be regu-larly referred to stressful event, may serve as paradigm to understand pathological base of the mind-heart relation. Further research is essential with regard to pathophysiology and pathopsychology, but it is our duty to struggle for care in everyday practice.