Brief Answer: Orthostatic hypotension likely Detailed Answer: Dear XXXXXXX Thanks for the query. It is not uncommon for patients with CHF to have orthostatic hypotension given the significant number of blood pressure related medications they take, and it sounds that this may be your case as well. Sometimes as heart failure progresses dose adjustments have to be made on medications; a good test for you in this regard would be an ambulatory blood pressure monitor, with which you can also record symptoms in case you have a spell, and see if it correlates with a drop in the blood pressure. There may also be a component of autonomic dysfunction, given that you tell us that additionally you are experiencing peripheral neuropathy and glucose swings. An autonomic function test, including tilt-table test may prove beneficial for diagnosis. Yours truly, Dr Brenes-Salazar MD Cardiology Mayo Clinic MN

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