Cardiovascularmiddle twist
A 59-year-old man presents 90 minutes after onset of severe central chest pain with sweating and nausea. The ECG shows 3 mm ST-segment elevation in leads II, III and aVF, and he is given aspirin and sublingual glyceryl trinitrate while the catheter laboratory is prepared. Five minutes later he feels faint: his blood pressure has fallen from 128/80 mmHg to 84/56 mmHg and his heart rate is 56/min. His neck veins are distended and his lungs are clear on auscultation. Which one of the following is the most appropriate immediate management?