Please identify the following heart rhythm:

Choice A rationale:

Digoxin is a medication that slows the heart rate. It would be contraindicated in this patient because they are already bradycardic.

Administering digoxin could further slow the heart rate and worsen the patient's symptoms.

Additionally, digoxin can have a negative inotropic effect, which could further compromise the patient's hemodynamic status. Choice B rationale:

While it is important to continue to monitor the patient, this is not an intervention that will address the patient's bradycardia and hypotension.

The patient is already symptomatic, and their heart rate and blood pressure are likely to continue to decline without intervention. Choice C rationale:

Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia.

It is not indicated for sinus bradycardia.

Choice D rationale:

Transcutaneous pacing is a non-invasive method of pacing the heart.

It can be used to temporarily increase the heart rate in patients with symptomatic bradycardia.

This is the most appropriate intervention for this patient because it will address the underlying problem of bradycardia and improve the patient's hemodynamic status.

Choice A rationale:

Pain relief is a primary benefit of morphine administration in the setting of myocardial infarction.

Pain can trigger a stress response, leading to increased heart rate, blood pressure, and myocardial oxygen demand.

Morphine effectively reduces pain, thereby lessening the stress response and its detrimental effects on the heart.

This helps to minimize myocardial ischemia and potential further damage to the heart muscle.

Pain control also improves patient comfort and overall well-being, which can indirectly contribute to better cardiac outcomes.

Choice B rationale:

Sedation is another important benefit of morphine in this context.

It promotes rest and relaxation, which can lower heart rate, blood pressure, and myocardial oxygen demand.

This is crucial for patients with myocardial infarction, as their hearts require reduced workload to heal and recover.

Sedation also helps to alleviate anxiety and agitation, which can further strain the heart.

By inducing a state of calmness, morphine can indirectly protect the heart from additional stress.

Choice C rationale:

While morphine does have diuretic effects, increasing urinary output is not a primary goal in the management of myocardial infarction.

In fact, excessive diuresis could potentially lead to dehydration and hypotension, which could be detrimental to cardiac function.

Therefore, while morphine may slightly increase urine output, this is not a major reason for its use in this setting.

Choice D rationale:

Decreasing myocardial demand is a key benefit of morphine administration in patients with myocardial infarction.

Morphine achieves this by:

Reducing pain and the associated stress response

Promoting sedation and relaxation

Diminishing anxiety and agitation

Exerting a direct vasodilatory effect on blood vessels

This collective action of morphine leads to a decrease in heart rate, blood pressure, and the heart’s overall workload.

As a result, the heart requires less oxygen and experiences reduced strain, allowing for better healing and recovery following a myocardial infarction.