Shortness of breath, not fluid overloaded


Hello Dr. Agar,

I have been experiencing a little shortness of breath on the days after I skip a treatment. I normally do HD five nights a week, 7.5 hours each night. I put on only about 1.5 - 1.7 kgs. Despite this, I have these symptoms. I used to be able to withstand weight gains of more than 4 kgs without any symptoms in the past.

I have tried removing more fluid as suggested by my nephrologist but I feel I am going below my dry weight if I did that. So I am definitely not fluid overloaded.

My nephrologist referred me to a Cardiologist who got an Echo cardiogram. The Echo report said I have a dilated LV, Grade 1 Diastolic Dysfunction and Biatrial Enlargement. I was asked to get a Dobutamine Stress Echo in which they could reach a heart rate of only 116 /minute as opposed to a desired HR of 140 /minute. They ruled out severe ischemia but said I may have slight ischemia but the test was inconclusive.

My cardiologist and nephrologist are only giving me vague explanations of the above with a ‘nothing to worry’. They are not giving me any workable solutions for the shortness of breath.

I was wondering what the above meant for my heart? Any suggestions on the Shortness of breath?


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My LV Ejection Fraction is 62%


Despite your EF of 62, you do have a dilated LV with diastolic dysfunction, so this could still be overload … you may have lost body weight and not brought your target weight down sufficiently to match the loss. If your BP permits, I tend to agree with the advice your team have given … and to be frank, they are FAR better placed and able to advise this than I am. Some carvedilol might help, too, but AGAIN … discuss this with your team. To me, it sounds like you have fluid on board that you don’t think you have … if your BP allows, I would be gently dropping your target weight over several successive treatments. But, Kamal, trust your team, not me. This is stuff that needs local guidance and not internet medicine!