The ABCs are already accounted for. In the setting of an unsecured aneurysm, it's reasonable to maintain a goal SBP < 120 for now (unless they're chronically much higher than that). The ED already consulted cardiology and activated the STEMI pager. The interventional cardiology fellow is now paging you and asking you if they can take the patient to the cath lab.
This is where it's helpful to know what getting a left heart catheterization (LHC) with coronary angiography entails, and how it'd affect our own management. (If in doubt, ask cardiology to clarify!) It's totally reasonable and expected to call cardiology for this, because there's a real concern that the patient is having an OMI. If so, and the patient is having an acute coronary plaque rupture, the management would include catheterization-- requiring heparin boluses-- and if they place a coronary stent, then dual antiplatelet therapy (DAPT) would be required for the next several months at least.
So, for our patient here, the presence of an unsecured aneurysm, that did acutely rupture, makes the risk/benefit profile for pursuing LHC prohibitively unfavorable. Heparinization and DAPT would raise the bleeding risk too significantly. She also needs an EVD now. This is a tough spot to be in. LHC is out of the question right now, unfortunately. But, hopefully it's just stress-induced changes (e.g. contraction band necrosis) secondary to her aneurysmal rupture rather than true coronary plaque rupture.
The cardiology fellow understands our reasoning and is happy to defer LHC. They recommend initiation of a statin and to call them back when we think it'd be safe, from a neurologic perspective, to pursue LHC.
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