This has the huge possibility of being R sided failier caused by a R sided inferior MI. Nitrates are contraindicated in this type of MI simply because of the pressure.
Tx.- R sided 12-lead (which isn't done enough w/ inferior presentation) C-Pap/Bi-Pap would really help. Deffinatley did the right thing with the ASA. Now EPI and or Atropine would give you your rate and pressure but you gotta remember that you don't want to increase O2 demand because heart tissue is priceless. Maybe a slow dopamine drip and if your rales don't clear up a moderate dose of lasix. If you decide at this time to give NTG than make sure you have a thousand bag hanging with a nice gauge to get it through preferably in an AC. A fluid challenge is proven to be successfull in a rapid drop of the BP with a R-sided MI. Or skip the nitro and use morphine to decrease the O2 demand and afterload. Now a simple BLS measure like trendelenberg could be done as well to assist you in managing the BP. I think the rate will fix itself if you treat the pressure and rales.
The brady rythym could be occuring in response to a couple of things. This patient could very probably be in cardiogenic shock and it's decompansating. So if you fix your perfussion problems with the pressure the rate should come up. Or the pt. could have some serious heart tissue damage impeding electrical impulses which I doubt because of the narrow complex.
If the brady is still present I would sedate and pace. Reason being that this pt. is having an MI and any sympathomimetic or parasympathetilytic is going to make the heart work harder especially since we are allready doing that with the dopamine. Pacing will get your rate up if it hasn't gone up after the tx. of the pressure.
