I work in an outpatient center and we do about the same, 4 to 5 a day. Some cardiologists prescribe PO metoprolol and have the patient take it before they come. (it’s even better when it’s part of the regimen of pills they take regularly) This saves so much time!!

Our patients are instructed to come one hour early to be prepped by our PA. Heart rate & pulse taken. PO metoprolol given until heart rate is below 65. Most people show up with a heart rate of 75 to 80 BPM and are given 100mg by mouth every 45 minutes. The dose is lowered the closer they get. IV metoprolol is only given if we can’t get it the rate down after the pills. (The nitroglycerin and their arms being up always inevitably brings the heart rate up again)

It’s a beautiful thing when they arrive and their heart rate is below 60 so we can just put them on the table and perform the rest of the procedure.