A 52-year-old woman with headache and bradycardia.

Cardiac sarcoidosis should be suspected in young patients with cardiac symptoms, especially when there is concurrent personal or family history of sarcoidosis. While sarcoidosis is self-limiting in about 40% of cases, cardiac involvement portends a more ominous prognosis with higher mortality rates. The definitive diagnostic test for cardiac sarcoidosis is the endomyocardial biopsy, an invasive test with low sensitivity. The multiple clinical modalities, which comprise the Japanese Ministry of Health clinical diagnostic guidelines, and newer modalities, including MRI, are more sensitive and demonstrate reliable diagnostic efficacy when compared to endomyocardial biopsy. Management of cardiac sarcoidosis involves early initiation of corticosteroid therapy to limit progression and maintain the structural and electrical integrity of the heart. When necessary, more invasive modalities (e.g. ICD, pacemaker, and transplant) may improve outcomes in advanced disease.