Start with finding a cardiologist that is a runner him/herself. They understand where you're coming from in regards to trading workouts for pills. Then if they tell you you still need to be on Metroprolol I'd trust their recommendation. I'm on statins in the winter months when my diet is not so good and I don't train as many hours. I'm on BP medicine as well but when I go from 5 hours a week to 10 or more I start getting light headed every time I stand up. Then we cut that dosage in half.

I'm no MD, but I can tell you when I was on it about 2 years ago, there was no way in hell I could even think about training (for any distance). Quick backstory: went into afib one random day, none of the drugs would get me out, cardioverted back to normal rhythym - followed by Metro or a similar prescription (can't remember the dosage). That lasted all of about 4-6 weeks before I told the doc it was a no-go: I am a technology consultant and travel frequently, and I could hardly get out of bed let alone train at all. I was exhausted all the time.

I had a conversation with the prescribing cardiologist and convinced him to let me wean off. He agreed basically saying "OK but you'll probably have another episode". 6 months later I did, cardioverted again, then an ablation in October 2015. No ill effects since.

I'd suggest having a deep conversation with your cardio guy to weight the pros and cons. Personally I'm curious what is the point of taking the drug if the ICD corrects the arrhythmia? That seems like a less constantly-invasive thing than the drugs, which I'm guessing will have a similar effect on you. Best of luck though.

Thanks a bunch fellas (Jimmy and Matty),

Your thoughts are very helpful.
I am planning on having a deep discussion with my cardio guy...I am not too excited at the thought of getting shocked again but, when needed it is a life saver. It does provide a solid plan against tachycardia and as you mentioned is less adverse overall than beta-blockers.

My experience is similar to some of those mentioned above.

I suffered a heart attack near the end of a short, easy run last February. For the first few months following I was taking Lisinopril (ACE Inhibitor), Metoprolol (Beta Blocker), Clopidogrel (Plavix), and a statin. Once I started to become more active, I would become very light-headed every time I stood up after sitting. I would also become so tired by late morning that I needed a long nap by lunchtime.

Fortunately my doctor is a competitive swimmer and is very understanding of my concerns. We began cutting back on the ACE Inhibitor until I was completely off of it, and then began to wean off the Metoprolol. Unfortunately, once I was down to half of a 25 mg. tablet daily, my BP went back into the slightly high range. So, I'm currently holding at 25 mg. per day and I still find that I feel drained by mid-afternoon, but no longer have issues with the low BP light-headedness.

I'm now training pretty consistently again and can function pretty normally for most of the day. I do feel like the meds are holding me back on regaining my previous endurance levels but I am making progress, just not as quickly as I would have expected in the past. I'm sure it doesn't help that I'm not getting any younger.

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Happy trails,
Chris

Thank you for sharing your experience Chris, it is just what I was hoping for.
Unfortunately for me there may be a bit of disconnect between myself and Dr. Mohommad...unless he competed in endurance sports while attending University of Cairo 😕

After reading this thread I hope to clarify a few things:

1) My background: I am an exercise physiologist working with cardiac patients for the past three years at a hospital in Chicago. I have both a Bachelors and Masters in Exercise Physiology, as well as a triathlete and endurance athlete. So after reading a few other peoples posts I think I have a better background/understanding to hopefully help.

2) "Jimmytheeagle" & "Tricyclist" I agree with. I know a few cardiologist here in Chicago (granted major hospital) that work with only athletes, thus having a better understanding of what we may be going through and your concerns. Also, medications are given to a patient to help, dosages are sometimes needed to be tweaked depending upon the patient to get the best results.

3) Please if anything do not follow "mattyboy" advice. Your ICD is a last resort if your heart goes into an arrhythmia. It should not be used as a fall back because you do not want to take your meds. Metoprolol is not only used for decreasing high blood pressure, but it is also used as an anti-arrhythmic medication. Thus why "mattyboy" went back into AFib and had to get cardioverted. Getting cardioverted and/or having your ICD fire is a lot more painful, worrisome, and expensive then taking a pill a day.

I understand your troubles with trying to train at a high level and being able to sustain it if for an IM distance. You are put on these medications for a reason by the doctor because of your medical history. My advice speak with your cardiologist and voice your concern. Usually with my cardiac patients I advise them to keep a log of when they feel sluggish, their blood pressures at various times of the day, and any other sort of signs/symptoms to bring to their MD. Many times they will just decrease the dosage, but not completely take you off of the medication. With metoprolol you may have low blood pressure causing some sign/symptoms, but you still need to be on it for the anti-arrhythmic aspect (to keep you out of Tachycardia)

Hope this helps and please let me know if you have any further questions.

Cheers

pkeys00,

Thank you for taking some time to address my concerns. I found your contribution sober,reassuring and timely. I spoke with my 'new' EP yesterday and he was a wonderful active intelligent man about my age and understood more than I had ever expected. I was able to spend about 45 minutes with him discussing my current and past situation and what my intentions are for the future. He has a close friend that competes in IM regularly and is very active himself. He did a good job explaining the reasons for the metroprolol and also why it was preferred to "the back up plan of the defibrillator firing". I have had that happen before and it does take a while to recover from it, especially psychologically.
We agreed to try 12.5mg dose once a day. A huge reduction from the original script of 25mg x2 a day. I am going to try the once a day dose for 5-6 days then go up to 12.5 2xday and record feelings and training data and I meet back with him in two weeks for device interrogation and come up with a plan based on the info we collect in the mean time. I am hopeful at the low dosage I feel no negatives but still get some benefit from the medication.

Sincerely,
Chad

That is great to hear! Hope all goes well with the medication and your upcoming races!

Patrick