A middle-aged man presented with near syncope and complete heart block. Multimodality thoracic and cardiac imaging, together with histology, established the diagnosis of thoracic sarcoidosis with myocardial involvement. This case highlights an uncommon miliary pattern of pulmonary sarcoidosis and underscores the value of combined cardiac MRI and FDG PET-CT in identifying active cardiac sarcoid as the cause of conduction block, prompting timely immunosuppressive and implantable cardiac defibrillator placement.