A 45 year old male with a history of hypertension and dyslipidemia presents to the emergency department with substernal chest pressure for 1 hour. The pain occurred at rest, is 10/10 in severity and is associated with shortness of breath. His temperature is 37.1 C, blood pressure 80/50, heart rate 90, and respirations 20. His laboratory studies are normal. His ECG is below.
What is the appropriate initial management?
A. Intravenous beta-blockers
B. Sublingual nitroglycerine
C. Intravenous heparin
D. Intravenous dobutamine