Combination regimens, especially CTLA-4 plus PD-1/PD-L1, confer the highest risk of severe cardiovascular immune related adverse events (irAEs), with myocarditis being the most frequent and often presenting early in the treatment course. Vigilance for early symptoms and prompt management are critical, as recommended by the American Society of Clinical Oncology [45]. Here, CTLA4 is linked to myocarditis.