Heartbeats interrupted - unveiling cardiac sarcoidosis.

Cardiac sarcoidosis is a rare but potentially deadly complication of systemic sarcoidosis, in which the heart is affected by immune dysregulation and granulomatous infiltration. We present a case of a 65-year-old woman who presented with worsening breathlessness and bradycardia secondary to complete heart block. Workup with cardiovascular magnetic resonance imaging showed an increased signal on late gadolinium enhancement sequences in the anteroseptum and inferoseptum consistent with active infiltration from cardiac sarcoidosis. High-resolution computed tomography of the chest showed multifocal ground-glass opacities with a peribronchovascular distribution in keeping with sarcoidosis. A dedicated CT scan of the chest showed bilateral hilar lymphadenopathy. A further positive emission tomography scan confirmed the diagnosis of cardiac sarcoidosis in the left ventricle. The findings were discussed in the cardiology multidisciplinary team meeting and it was decided the patient needed an implantable cardioverter defibrillator with further follow-up with the respiratory and cardiology team.