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There are often remarkably long delays in the diagnosis of cardiac sarcoidosis. We present a case of a 61-year-old man with exertional dyspnea and light-headedness. A resting ECG showed a 1st-degree AV block. A complete heart block was unmasked by an exercise stress test. The coronary angiogram was normal as were the cardiac troponins and Lyme antibody titer. He received a pacemaker on an emergent basis. Cardiac PET scan confirmed sarcoidosis. Computed tomography of the chest was significant for hilar and mediastinal adenopathy. He was treated with methotrexate with good symptom relief. This case demonstrates the importance of prompt clinical suspicion and immediate stress testing to unmask higher degree heart blocks in patients with cardiac sarcoidosis, which would have been missed otherwise. Treatment with a pacemaker, an ICD, and an immunosuppressant is recommended in such patients.

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Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License