Dear friend, welcome to HCM.
what is her BP?
controlled well? how long is she on these meds?
is arkamine a new addition?
arkamine can cause drowsiness
(it is not an anti depressant!), so also low sodium (especially on diuretics).
I see these as prominent causes.
else many differentials.....
pl. get her electrolytes checked.
I hope to have answered you clearly. pl. keep me posted on the progress.