<p>In contrast to the general population there is evidence of elevated cardiac mortality in patients with psychiatric disorders. There is a direct causal association between psychiatric disorders and elevated cardiac mortality through hematological and hormonal processes and the increased use of psychotropic drugs also leads to an increased cardiological risk. Psychotropic drugs influence the heart rate and blood pressure and changes of cardiac depolarization and repolarization to a varying extent, depending on the substance group. Among these, QTc prolongation is the most important but the clinical relevance is mostly dependent on the interaction between a variety of risk factors. These effects and the different side-effect profile of psychotropic drugs, and the recommendations on the clinical approach are elucidated in an overview.</p>