Atropine only has an effect on the part of the heart innervated by the vagus nerve. This stops at the AV junction. You will probably not get much of an effect with the Atropine. Pacing would be more helpful ( if you can get capture). According to most patients (strictly speaking of my own experience) pacing is not so much "painful" as it is "uncomfortable". I understand that we want to decrease their discomfort; hopefully the pacing will increase perfusion enough to give some nice sedation and pain meds. I also agree with a judicious fluid bolus. Dopamine will possibly by helpful but you may not get the desired effect, even at high doses, if this pt has a hx of CHF or has been in cardiogenic shock long enough to deplete her norepi stores. Also, at this patients age, thrombolytics become a little risky.