Hi Doctor, The below mentioned details issued by the hospital: My cousin aged 33 yrs admitted in M.O.S.C.Medical College, Kolenchery, India, Kerala with Syncope . She is known to have Hypothyroidism . CT pulmonary angiogram done elsewhere recently showed pulmonary Artery & branches. No thrombus. Echo showed dilated RA, RV, PA, severe TR and severe PH. No VSD/ASD/PDA. She has been started on warfarin and sildenafil. Advised to start on Ambrisentan/Bosentan at a later date. Rt. heart study may help to assess pulmonary vascular reactivity. Kindly advise your report. Thks/Rgds Shaji