Hello! Welcome and thank you for asking on HCM! I understand your concern and would explain that your symptoms seem to be related to Vivance adverse effects. For this reason, I would recommend discussing with your attending physician on the possibility of switching to another therapy. Some blood lab tests (complete blood count, PCR, ESR, kidney and liver function tests, thyroid hormone levels ) are necessary to exclude other possible metabolic causes. Hope you will find this answer helpful! Wishing all the best, Dr. Iliri