There are many causes for shortness of breath including a leaky mitral valve. Normally, the mitral valve allows blood into the left ventricle when it is filling and should close when the heart is contracting. When the mitral valve has a severe leak, increased fluid pressure behind the heart can cause the lungs to become distended with fluid–a condition called pulmonary edema.  Reduced forward heart delivery of blood to the body can contribute to symptoms of fatigue. A definitive therapy for severe conditions could include surgery to repair or replace the leaky valve when a patient’s general condition would permit this. Medical management through diuretics (medicines that increase the excretion of salt and water by the kidneys) may decrease fluid overload of the lungs and improve shortness of breath. Medicines that dilate blood vessels can also reduce an increased fluid pressure. A diet low in intake of sodium can reduce the fluid pressures within the circulation and also help.  A decision for surgery should be thought about carefully due to increased risks associated with older age.