Diltiazem

I've been slowly having fatigue for a few years now, but the last year it has been getting worse.

I was diagnosed with obstructive HCM a year ago and started metoprolol back in November 2024 after an incident of sepsis in the hospital. My fatigue was getting worse since then, so my cardiologist had me back off to half my dose in February after seeing my resting heart rate is between 40-50bpm.

The fatigue hasn't gotten better so he wants me to stop taking metoprolol and see if the fatigue goes away. He said if it does, the backup would be Diltiazem to try next.

Has anyone had this medication and/or gone through this process of trying different medications?

I have some angina, but mostly just fatigue (which could be related to anything). My heart rate has been weirdly all over the place lately. It was fairly low/stable from November through March and then started getting weird the last month. Simple task of getting up to walk to the fridge could go from a 50bpm to 120bpm. No dizziness but feel my heart racing so I check.

My cardiologist is local to me, but I'll be seeing a second opinion in June in a more specialized heart center at Kaiser (Santa Clara) with a cardiologist that was at Stanford's HCM center.

Part of me is wondering if I just wait to make any changes until then but I had not heard of this medication so was wondering of others experience.