<P> First - degree heart block does not require any particular investigations except for electrolyte and drug screens, especially if an overdose is suspected . </P> <P> Investigations may also be warranted with a prolonged interval that is greater than 0.2 sec . </P> <P> The management includes identifying and correcting electrolyte imbalances and withholding any offending medications . This condition does not require admission unless there is an associated myocardial infarction . Even though it usually does not progress to higher forms of heart block, it may require outpatient follow - up and monitoring of the ECG, especially if there is a comorbid bundle branch block . If there is a need for treatment of an unrelated condition, care should be taken not to introduce any medication that may slow AV conduction . If this is not feasible, clinicians should be very cautious when introducing any drug that may slow conduction; and regular monitoring of the ECG is indicated . </P> <P> Isolated first - degree heart block has no direct clinical consequences . There are no symptoms or signs associated with it . It was originally thought of as having a benign prognosis . In the Framingham Heart Study, however, the presence of a prolonged PR interval or first degree AV block doubled the risk of developing atrial fibrillation (irregular heart beat), tripled the risk of requiring an artificial pacemaker, and was associated with a small increase in mortality . This risk was proportional to the degree of PR prolongation . </P>

What to do for first degree heart block
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