The study examined the illness perception dissimilarities between chronic cardiac patients and their spouses, as well as the associations of perception dissimilarities with patients' overall self-rated health (SRH) and illness-related coping strategies. Seventy-three patients (65 males, 8 females) with an old myocardial infarction and subsequent cardiovascular problems, and their spouses completed the Revised Illness Perceptions Questionnaire. Patients also completed a coping measure (the Coping with Health Injuries and Problems Scale) and a question regarding SRH. Significant differences, with spouses scoring higher than patients, were found in perceptions regarding illness chronicity, personal control and the emotional impact of the illness. The correlations of dissimilarity scores to SRH and coping were sporadic and weak. Additionally, after controlling for patients' own perceptions, the effects of dissimilarity scores almost disappeared. However, when three different groups were constructed reflecting whether both partners scored high, low, or in an opposing way on each IPQ-R subscale, the overall matching in several illness perceptions was associated with certain coping strategies, even after controlling for the effects of the patients' own perceptions. With respect to SRH, no significant effects were found.