People with psychotic disorders such as schizophrenia die 15-years prematurely, mainly due to cardiac disease. Converging lines of evidence point towards a genetic overlap between psychosis, cardiac inflammation, and heart failure, with immune pathways implicated. However, there is also evidence for cardiac inflammatory effects of antipsychotics, the main treatment for people with psychosis. This talk will examine the unique pathways potentially contributing to cardiac dysfunction in people with psychosis, considering genetic, imaging, and pre-clinical data. The implications for clinical practice will be discussed.