Pulmonary arterial hypertension

30 year old male .with severe PAH on echo report .operated for vsd 10 year back .had 3 episodes of fainting in last 2 to 3 years .yesterday he developed fainting after stopping sildenafil 20 mg bd which was he advised to take for 2 weeks.,and and dytor.after stopping that he developed periorbital edema ..and 1 episode of fainting advise further management.

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As he is post operative c/o vsd having PAH pt is on sidenafil 20mg and dytor Still pts 2decho suggest PAH with rt atrial dilatation and RV dysfunction I will suggest for ecg And i will like to add bosantan 67.5 mg 1od at bedtime Also adv for MRI brain
Thank you doctor
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