When treating a hypotensive patient with bradycardia, what is the initial therapeutic approach?

When treating a hypotensive patient with bradycardia, the initial therapeutic approach is to administer atropine. Atropine is an anticholinergic agent that works by blocking the action of the vagus nerve on the heart, which increases heart rate by inhibiting parasympathetic activity. This increase in heart rate can help improve cardiac output and subsequently support blood pressure in a patient who is experiencing both hypotension and bradycardia.

In the setting of symptomatic bradycardia (especially when accompanied by hypotension), atropine is typically the first-line treatment. It is important to address the bradycardia quickly, as it can lead to inadequate perfusion of vital organs.

Other approaches, such as glucagon and calcium supplements, may have their place in specific situations (for example, glucagon in beta-blocker overdose), but they are not the first-line treatments for addressing this combination of hypotension and bradycardia. Discontinuing medications may be necessary if the bradycardia is a result of drug therapy, but it is not a direct therapeutic intervention for acute management. Hence, the first-choice agent should be atropine to rapidly correct the heart rate and help stabilize blood pressure.