Exercise intolerance and multiple conduction abnormalities as first manifestation of cardiac sarcoidosis

Sarcoidosis is a multisystem disorder of unknown cause, characterized pathologically by noncaseating granulomas. It is more commonly seen in younger adults and African Americans. Myocardial involvement occurs in at least 25% of patients with sarcoidosis and is associated with poor prognosis. In spite of recent advances in imaging modalities, early diagnosis of cardiac sarcoidosis (CS) remains very challenging. Cardiac disease as the first manifestation of sarcoidosis is rare and therefore, requires a high index of suspicion from the physician. We present a case of CS manifested initially as exercise intolerance secondary to severe cardiac conduction abnormalities.