Sarcoidosis with cardiac involvement is underdiagnosed and can put patients at risk of morbidity including conduction defects, arrhythmias and heart failure, as well as sudden cardiac death. In addition, cardiac sarcoidosis may have no clinical manifestations or non-specific presentation and diagnosis may be difficult on clinical criteria. Investigation for cardiac sarcoidosis should be considered in those with extra-cardiac sarcoidosis and cardiac findings as well as those under the age of 60 years presenting with atrioventricular block without a clear cause. Advanced imaging modalities including cardiac magnetic resonance and positron emission tomography may help in both the diagnosis and assessment of response to treatment for cardiac sarcoidosis. This ultimately may help to minimize associated adverse outcomes from this enigmatic disease.