Bi-fascicular block on EKG as the initial presenting sign of cardiac sarcoidosis

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A 41-year-old commercial painter with a history of tobacco use presented to the emergency department with complaints of cough, pleuritic chest pain and worsening dyspnea with exertion beginning 3 days prior to arrival. He had not responded to an outpatient regimen of bronchodilators and antibiotics. The patient denied any constitutional symptoms.