### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Dear Sir, I am Nilkanth Pancholi (Male) age 39yrs. from Ahmedabad, Gujarat and doing job in purchase dept. of a pvt. ltd. co. I am suffering from PAH (Pulmonary Artrial Hypertension)since last 6 yrs. First my family doctor once checking me while fever, told that there is some murmur noice in your heart and advise me for check up. At that time before around 6 yrs I was been informed about PAH. I was given Sildenafil (Penegra) drug and I took it for 5 months. Then after I did not took any drug for 4 yrs. Thenafter I visited again doctor and it measured near 100. I was given Bosentan (Lupibose) drug and I took it for 10 to 12 months. Thenafter I m not taking any drug since now. These days if i walks fast or goes up even on first floor I breaths faster. I feel tired and feels to seat for a while. Even I lift some weight my breathing starts faster.Sir, please advise me what should I do, what is the available treatment for this or what should I take care of. Pl. advise me. Thanking you,Best RegardsNilkanth Pancholi

### output:

Hello Ninth, First the cause of pulmonary hypertension should Evaluate and specific treatment for the same would be most effective. If it's found to be idiopathic or primary (without any cause), a High heart catheterization (Talk to your Cardiologist) for the same would help determine vasodilator reactivity. Lastly it's not wise to stop medication, rather the pulmonary pressure described by you, a combination of both sildenafila and Bosnian should be considered. Fine titration by your doctor is the best way forward. Regards Chat Doctor. 