 Hello, I am Dr. Devananda, Head of the Department of Cardiac Surgery at Manipal Hospital. I have been practicing cardiac surgery for the last 18 years. When the mitral valve starts leaking, the symptoms which we can experience depends on the amount of leak and how quickly the leak comes. Now, if it is a very gradually developing leak, say the leakage is very mild, very small initially, probably we might have no symptoms, absolutely no symptoms even at normal work or even extreme work. Now, as the leak progresses, say goes to moderate level, one might experience little bit of palpitation. In layman times, you start noticing your heartbeat. Every time I do some activity where I am not supposed to experience my own heart beating faster, you notice that the heart is beating faster. When the leak goes to a severe levels, one might start developing easily fatigability. In the sense, what routinely you wouldn't get tired of, you start getting tired of with an activity like that. That's the common, these are the symptoms. The symptoms of severe heart failure like becoming symptomatic, even at very minimal activity or even at rest. And second thing, breathing difficulty when you lie down or legs kind of getting swollen, these are all the symptoms of advanced heart failure which happens secondary to prolonged leakage of the mitral valve. That might take a lot of time and that's generally we get the symptoms when this leakage and the heart failure is quite advanced. What I meant is, mitral valve regurgitation, unlike mitral stenosis, becomes symptomatic quite late in the disease.