Cardiac invalidism is a term used repeatedly in the literature during the past few decades, but little attention has been given to studying the variables contributing to this phenomenon. Data were collected from 111 patients with first acute myocardial infarction. Patients were visited at home 1 month and 4 months after hospital discharge. Social support, self-esteem, health perceptions, emotional distress, interpersonal dependency, and neurotlcism were measured using standardized instruments. Illness severity was determined using the Coronary Prognostic Index, the Specific Activity Survey, and treadmill testing results. Neuroticism and social support were significant predictors of cardiac invalidism 4 months after myocardial infarction. Illness severity was not a significant predictor of cardiac invalidism or return to work. The only significant predictor of return to work was health perception. Patients receiving more support than desired experienced less cardiac invalidism after acute myocardial infarction. Physicians are encouraged not to assume that patients with large infarcts will become cardiac invalids. Psychologic recovery may require more than 4 months for many patients, but positive messages regarding patient health can influence such outcomes. Families and friends should be taught to provide appropriate types and amounts of support. The amount of support typically thought to be adequate may not be sufficient. Patients who initially receive more support than desired experience the best psychologic outcomes. High levels of support need not continue indefinitely.