A 55-year-old man arrives at the emergency department after experiencing an hour of intense substernal chest burning and sweating. He has a history of obesity as well as diet-controlled type 2 diabetes. On initial examination, the blood pressure is 110/70 mm Hg, and the pulse rate is 60 beats per minute and regular. On room air, oxygen saturation is 98 percent. The patient is lying flat and there are no heart murmurs heard. Auscultation reveals that the lungs are clear. The initial ECG reveals a normal sinus rhythm with a 2-mm ST-segment elevation in leads II, III, and aVF. Aspirin and morphine are given. The patient becomes dizzy as he is about to be transported to the catheterization lab for an urgent percutaneous coronary intervention, and the telemetry monitor shows sinus bradycardia at 40 beats per minute. The patient appears pale and diaphoretic and peripheral pulses are faint. Blood pressure is 70/40 mm Hg. Which of the following is the best immediate step for managing this patient's condition?

Question

A 55-year-old man arrives at the emergency department after experiencing an hour of intense substernal chest burning and sweating. He has a history of obesity as well as diet-controlled type 2 diabetes. On initial examination, the blood pressure is 110/70 mm Hg, and the pulse rate is 60 beats per minute and regular. On room air, oxygen saturation is 98 percent. The patient is lying flat and there are no heart murmurs heard. Auscultation reveals that the lungs are clear. The initial ECG reveals a normal sinus rhythm with a 2-mm ST-segment elevation in leads II, III, and aVF. Aspirin and morphine are given. The patient becomes dizzy as he is about to be transported to the catheterization lab for an urgent percutaneous coronary intervention, and the telemetry monitor shows sinus bradycardia at 40 beats per minute. The patient appears pale and diaphoretic and peripheral pulses are faint.  Blood pressure is 70/40 mm Hg. Which of the following is the best immediate step for managing this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Conduction abnormalities are common in acute inferior wall myocardial infarction. Sinus bradycardia is frequently caused by nodal ischemia and an increase in vagal tone caused by myocardial infarction; the increased vagal tone can be counteracted by the anticholinergic effects of atropine.

A 55-Year-Old Man Arrives at the Emergency Department After Experiencing