Pain in the heart 3. Why the heart often hurts: diseases of the lungs and esophagus. If the pain radiates to the left hand

Pain in the heart is a symptom of multiple problems, but not always of the heart. This is how pathologies can manifest musculoskeletal system, respiratory organs, gastrointestinal tract, neurological disorders. Therefore, each of us needs to know how to distinguish pain in the region of the heart associated specifically with his disease in order to prevent serious complications such as myocardial infarction.

Unpleasant sensations in the chest area received a collective name in medicine - cardialgia.

What pathologies can pain speak of?

Pain in the heart area can indicate many pathologies. Hearts include:

• ischemia (angina pectoris, arrhythmias, myocardial infarction, postinfarction cardiosclerosis);
• inflammation of the myocardium, with a violation of the main functions of the muscle: excitability, conduction and contractility;
• myocardiopathy;
• myocardial dystrophy;
• heart injury;
• neoplasms.

Pathologies manifested by heart pain:

• esophagitis;
• gastroesophageal reflux pathology;
• stomach ulcer;
• malignant neoplasms;
• chemical burns of the mucous membrane of the esophagus, stomach;
• Mallory-Weiss syndrome, accompanied by gastric bleeding;
• ulcer perforation;
• pneumonia;
• pleurisy;
• tuberculosis;
• pneumoconiosis;
• aneurysm or dissection, congenital narrowing of the aorta;
• thrombosis pulmonary artery and etc.

Put correct diagnosis after a detailed diagnosis, only a specialist can.

The nature of pain

Pain in the heart area may be different character and intensity. Therefore, you should know what pains in the heart are in order to prevent its complications. Let's take a look at their types.

• Compressive

Constant compressive pains in the heart inform about the lack of oxygen in the myocardium - the heart muscle. Such a symptom is characteristic of almost all forms of ischemia (ischemia is a decrease in myocardial blood supply with a weakening, cessation of arterial blood flow).

Angina pectoris is characterized by compressive discomfort behind the sternum, radiating under the scapula and into left hand. Discomfort occurs almost always after physical exertion, at rest or after taking nitroglycerin preparations.

Constrictive sensations occur in people with various violations rhythm (bradycardia, tachycardia, arrhythmia). Often discomfort is accompanied by fear, shortness of breath. With such pathologies, compressive pain appears in the heart.

• Sharp

Sharp pains come on suddenly. They are characterized by the following pathologies:

1. Angina. Prolonged angina attacks, accompanied by a feeling of constriction, indicate thrombosis, embolism, abrupt stenosis coronary vessels. In such cases, nitroglycerin preparations do not help. If a person has taken two tablets with an interval of 10 minutes, but the discomfort does not go away, it is necessary to call ambulance. Only professional medical techniques will help prevent myocardial death - necrosis.
2. Myocardial infarction. This pathology is necrosis of the muscle wall. It is characterized by very pronounced, lingering sharp sensations that radiate to the stomach and are very similar to an attack. intestinal colic. It is not possible to relieve discomfort with nitropreparations. It is accompanied by lack of air, severe sweating, trembling hands, bouts of nausea and vomiting, loss of consciousness, arrhythmia. Often, people suffering from a heart attack experience convulsions, involuntary urination.
3. Pathologies of the digestive tract. The cause of acute, sharp discomfort in the chest is the perforation of a stomach ulcer. From a sharp attack, a person becomes ill, “flies” appear before his eyes, his head begins to spin, up to loss of consciousness.
4. Thrombosis of the pulmonary artery. Pathology is a blockage of the arterial bed lung thrombus. Tachycardia, shortness of breath, hemoptysis, fever, wet rales, cough can join the sharp pain. Thrombosis - emergency which requires urgent medical care.
5. Aortic aneurysm (the aorta is the largest major artery). Pathology is characterized by unpleasant sensations in the upper part of the sternum. The discomfort lasts for 2-3 days, usually occurs after exercise, is not observed in other parts of the body, and does not disappear after nitroglycerin drugs.
6. Aortic aneurysm dissection. Rupture of the aorta leads to the flow of blood between the layers of the walls of the vessel. When the wall breaks through, rapid massive blood loss occurs. talking in simple words, a huge hematoma is formed in the vessel. Often, the pathology develops in older men. The condition when blood accumulates between the layers of the aorta is characterized by a sudden sharp tearing discomfort behind the sternum or around the heart. Usually gives under the shoulder blade.

At the same time, pressure jumps are observed - at first it rises significantly, then drops rapidly. Characteristic features- asymmetry of the pulse on the hands, blue skin. A person sweats a lot, at the same time, he faints, his breathing is disturbed, his voice is hoarse, shortness of breath is observed. Hematoma leads to a lack of oxygen in the myocardium and coma.

• Pressing

Sudden pain and pressure in the chest develops with angina pectoris. The pain is paroxysmal, it can be relieved by taking nitroglycerin drugs. Distinctive feature between angina pectoris and a heart attack - an angina attack does not happen at rest and at night. Pressing sensations are almost always accompanied by jumps in blood pressure.

Pressing pains in the region of the heart can be the cause, symptoms (cardiac neurosis). In addition, a person will feel dizziness, arrhythmia, which are observed most often after a strong stressful situation, excitement.

Another reason for feeling pressure and discomfort in the chest is myocarditis. Symptoms: chest tightness, shortness of breath, increased heart rate, swelling lower extremities.

Myocardiopathy, myocardial dystrophy, neoplasms of the diseased heart also give pressing sensations. But in this case, discomfort does not arise from physical activity. Develops independently even at rest.

• stabbing

Many people perceive stabbing sensations as life-threatening pathologies. But such tingling indicates a neurosis. This condition is not life threatening. It is associated with an intense pace of life, a large load on the psyche. Any cardiologist, having heard from a person that chest pain is sudden, short-lived and looks like an injection, will say that this is not a cause for concern. Such symptoms do not indicate serious pathologies.

The causes of such pain in the heart can be irritability, nervous breakdown. Most often subject to such crises are emotional, strongly experiencing any, even the smallest troubles, people.

At constant anxiety, fear, emotional overstrain, adrenaline is reflexively released, which activates the vital important systems. In the process of evolution, the body has adapted to fight, for example, to attack or run away in the face of imminent danger. In the event that adrenaline is not spent on muscle mass, he is “trying to find” his realization in other organs, provoking stabbing sensations in the chest area.

• Strong

Unbearable severe pain in the heart may indicate a heart attack, pulmonary thrombosis, aortic aneurysm dissection. At the same time, the person is excited, rushing about. In addition to severe pain in the region of the heart, people experience intense fear of death.

• burning

Such pains in the heart are the following reasons: , pericarditis, cardiopsychoneurosis, heartburn with gastroesophageal reflux (reflux of stomach contents into the esophagus).

• Chest pain on inspiration

Shooting pains when inhaling from the side of the heart can be a sign of temporary infringement of the spinal nerves. Aching sensations at the exit - a symptom of protrusion (a pathological process in the spine, in which the intervertebral disc swells into spinal canal), intervertebral hernias. constant discomfort and frequent pain on inspiration in the region of the heart are formed against the background of a violation muscle tone and are expressed in muscle strain, as well as spondylosis (pathology spinal column, which consists in the growth of vertebral tissue in the form of spikes, protrusions), osteochondrosis.

How to understand that pain is associated with heart disease

There are a number specific symptoms, which will tell you how to determine that pain in the heart is associated precisely with its pathology. If at least a few of them are present, this is a reason to contact the cardiology center:

• painful sensation lasts at least 30 minutes;
• discomfort occurs during a night's sleep, at rest;
• pain in the heart and disappear after taking nitroglycerin preparations;
• pain in the region of the heart is periodically accompanied by suffocation, dizziness, fainting;
• pressure in the chest area appears after physical or psychological overstrain, pain in the heart radiates to the region of the left arm, shoulder blade;
• there is an increase in the frequency of contractions, rhythm disturbance without obvious reasons;
• the skin, while the heart hurts, turns pale, acquires a bluish tint, especially in the region of the nasolabial triangle;
• a person feels weak, sweats a lot.

Often, pain in the region of the heart is accompanied by aches, numbness of the muscles of the forearms. Then they rise to the muscles of the shoulder, give behind the sternum; sweat is intense; breathing becomes difficult; legs and arms "do not obey" a person.

What to do with heart pain

What to do if you experience pain in the heart area:

1. Take Corvalol. If the discomfort does not subside, then most likely the person has serious problems. In this case, you should call an ambulance.
2. Hold your breath for a while. But if at the same time the pain in the region of the heart still does not subside, this indicates serious problems, if it decreases, it indicates neuralgia or muscle problems.

Any kind of discomfort in the chest area should not be ignored. It should not be forgotten that many pathologies proceed secretly, can be perceived by people as a result of fatigue after physical exertion. To prevent development serious illnesses, life threatening you should visit a cardiologist.

Cardiovascular disease is one of the main causes of death: more than half of those who die from natural causes become victims.

Many factors lead to their development, from congenital pathologies and ending with stress and in the wrong way life. One of the first symptoms becomes pain in the heart.

However, chest pains do not always mean heart problems: problems with the spine, respiratory organs, gastrointestinal tract, and neurological disorders manifest themselves in a similar way.

How the heart hurts various diseases on what grounds can one distinguish cardiac pain from non-cardiac and what to do with sudden heart pain?

Heart pain symptoms

Not always the first signs serious illness are pronounced. In many cases, the heart practically does not bother a person for years, occasionally aches or reminds of itself every day with other unpleasant sensations, such as cold, heaviness, a feeling of squeezing in the chest.

A visit to a cardiologist to check if serious violations in the work of the cardiovascular system, it is necessary if you observe the following symptoms:

• After physical exertion or nervous tension in the chest area pulls, presses or burns, colitis nausea;
• While eating, walking, with laughter, shortness of breath, which at first glance appears to be unreasonable, begins;
• There is increased fatigue;
• erectile dysfunction in men;
• Numbness of the extremities, blue at the base of the nails;
• Snoring and sleep apnea, especially when lying on your back;
• Edema, especially swelling of the feet and hands. In the early stages, they are only visible indirect evidence- begins to press the shoes, the rings cut into the fingers. But even minor edema is a very serious symptom that speaks of circulatory disorders.

Visit to a cardiologist correct setting diagnosis and promptly prescribed therapy can save the life of the patient.

Causes of chest pain associated with the heart

Not all pains on the left side of the chest are cardiac.

Most common cardiac causes can be divided into several groups:

myocardial infarction

A heart attack is one of the most formidable heart diseases, without urgent medical care often causing the death of a patient.

Cause of a heart attack acute disorder blood circulation: blockage of a blood vessel by a thrombus or atherosclerotic plaque leads to necrosis of areas of the heart muscle that have lost their nutrition. The symptoms are the same for women and men.

Pain in a heart attack is not relieved by nitroglycerin and other drugs.

Extensive necrosis of the heart muscle is accompanied by loss of consciousness, blue lips and nails, respiratory disorders. In some cases, the discomfort characteristic of myocardial infarction is not accompanied by pain at all.

At the first suspicion of a heart attack, it is necessary to call an ambulance as soon as possible. It is impossible to cope with this condition on your own.

angina pectoris

Ischemic heart disease, or coronary artery disease, most often develops in men over 45 years of age, and manifests itself with angina attacks caused by spasm or narrowing coronary arteries and malnutrition of the heart muscle.

Her vernacular name, « angina pectoris”, Expresses the nature of the pain that manifests an attack - pressing sensation resembles the weight of a small but massive load.

Patients describe this feeling with the words "toad presses."

In addition to pain, which, as with a heart attack, often radiates to the neck, lower teeth, left hand, angina pectoris is manifested by interruptions in the pulse, shortness of breath, weakness, nausea and dizziness, sudden torrential sweat.

An attack may begin after severe physical or emotional load or without visible reasons- this suggests that the pathological process managed to go far enough.

In order to alleviate the patient's condition, it is necessary to provide him with peace and take nitroglycerin.

CAD rarely occurs in normal pressure, therefore, long before the onset of attacks, a person may be tormented by symptoms of arterial hypertension.

Dissection and rupture of an aortic aneurysm

A sharp, sharp pain on the left, so severe that it sometimes leads to loss of consciousness, is one of the main signs of aortic dissection or aneurysm rupture.

These pathologies often occur against the background of dysplasia. connective tissue, in which the heart muscle and large blood vessels more vulnerable than healthy people.

If the aorta ruptures due to an aneurysm or dissection of its walls, a patient without urgent medical care may die due to massive internal bleeding.

TELA

Blockage of the pulmonary artery by a thrombus leads to disruption of the lung-heart complex.

This condition is accompanied by the following symptoms:

With pulmonary thrombosis, nitroglycerin and other heart medicines do not help. Like most others vascular pathologies This condition is life threatening.

Inflammatory heart disease

Development different kind inflammation is most often caused by streptococcal and staph infection. Autoimmune processes, fungal infections, Pseudomonas aeruginosa, tuberculosis and syphilis lead to them.

To inflammatory diseases hearts are:

• Pericarditis- inflammation of the lining of the heart;
• Endocarditis- inflammation of the heart valves;
• Myocarditis- the heart muscle is directly affected.

The symptoms of pericarditis are similar to those of angina pectoris. It's pressing drawing pains in the middle part of the chest, accompanied by shortness of breath and palpitations and radiating to the neck, arm, shoulder, lower jaw.

In a sitting position, the patient breathes easier, and at night during sleep he tries to take a semi-sitting position.

The temperature usually rises to subfebrile.

Endocarditis is manifested by disorders heart rate, symptoms of heart failure - cyanosis of the skin, swelling of the extremities, face, accumulation of fluid in the abdominal cavity, shortness of breath.

Pain during inflammation of the heart valves remains mild for a long time, the clinical picture does not correspond to the real severity of the patient's condition. Even with timely treatment mortality from endocarditis reaches 30%.

With myocarditis, the heart stabs or pulls, attacks of pain are not associated with physical or nervous tension. Like other inflammatory diseases, it is accompanied by fever.

Excessive extensibility of chords - constrictions of connective tissue, to which "petals" are attached heart valve, leads to its prolapse.

Like an aortic aneurysm, this pathology is a frequent companion of connective tissue dysplasia.

Prolapse pain is not associated with physical and nervous overload, they are localized in the left side of the heart region, have an aching or squeezing character.

Their frequency and strength depend on how severely the functions of the heart valve are impaired.

Heart defects

Most often birth defects development of the heart is found even in the hospital and corrected in the first years of the patient's life.

But some of them give a pretty blurry clinical picture and are not immediately recognizable.

With age, when body weight and blood volumes increase, the strength of the heart muscle is no longer enough for full-fledged work. Heart defects are manifested by quite a variety of symptoms.

Where the pain is localized, how serious the concomitant manifestations are, how often and with what intensity they make themselves felt, depends on general condition patient and what kind of heart disease he suffers from. Only a cardiologist can determine the exact diagnosis.

cardiomyopathy

Most often, cardiomyopathy is a consequence of autoimmune processes. With it, the vessels and valves of the heart remain healthy, and arterial pressure less than normal performance, however, the heart muscle gradually thickens and loses its elasticity.

The strength, nature of the pain and where it is felt depend on the stage of the disease: with mild cardiomyopathy, the diseased heart reacts with increased heart rate, pressure and tingling to physical exercise, when severe - it hurts almost constantly.

Unpleasant sensations can be localized in any part of the chest and under the heart, nitroglycerin is ineffective against them.

Arrhythmia

arrhythmias various kinds women are most often affected. Some of them, such as sinus or respiratory arrhythmia, have practically no effect on health, and the patient may learn about them by chance during a planned ECG. Others, such as atrial fibrillation often lead to fibrillation and sudden death.

During an arrhythmia attack, pain is more likely secondary symptom, which occurs against the background of cardiac arrhythmias.

It is rarely very strong and does not go beyond the region of the heart.

Non-cardiac chest pain

Distinguishing heart pain from other pain is not easy enough, not everyone knows whether the chest can hurt due to reasons not related to the heart.

However, information about how exactly non-cardiological diseases manifest themselves will make it possible to understand what hurts even before visiting a doctor.

Osteochondrosis and herniated discs

Attack thoracic osteochondrosis easily confused with an attack of angina pectoris. With it, the patient experiences pressing pains that can radiate to left shoulder and hand.

An attack of pain is accompanied by a feeling of anxiety, fear of death. Most often, an attack is preceded by an unsuccessful fall, or an awkward turn, intense physical activity.

Spinal pain is not relieved by nitroglycerin, but, unlike heart pain, it is relieved by non-steroidal anti-inflammatory drugs such as Nise and Ketorol.

With intercostal neuralgia, most often occurring as one of the complications of herniated discs.

Unpleasant sensations in the form of burning, sharp or dull pains, aggravated by breathing, talking, sudden movements, often localized above or below the heart.

The patient can easily indicate where the source of pain is located and where it gives off. brightly pronounced reaction on any movement makes him breathe quickly, superficially and try not to move his hand from the affected side.

It is possible to distinguish intercostal neuralgia from heart pain by the absence of such accompanying symptoms as increased or interrupted pulse and difficulty in breathing that is not associated with unpleasant sensations.

Heart neurosis

frequent stress, hormonal disorders, increased excitability nervous system lead to the development of cardiomyopathy.

Long aching pain in the region of the apex of the heart, on the left side of the chest, accompanied by insomnia, anxiety, often appear after overwork.

Often cardioneurosis accompanies the onset of menopause. On the ECG, as in coronary heart disease, no changes are visible.

Sedatives and sedatives. This condition almost never leads to disruption of the heart muscle and does not threaten the life of the patient.

lung diseases

Pressing, accompanied by heaviness and shortness of breath, pain in the chest, accompanying diseases of the organs respiratory system, is almost always accompanied by symptoms such as cough, fever, noise in the bronchi. Therefore, it is difficult to confuse it with heart pain.

Diseases of the gastrointestinal tract

Cramps in the stomach due to many different causes, burning pains behind the sternum, caused peptic ulcer or acute gastritis With hyperacidity are often accompanied by nausea and vomiting.

In some cases, they are so intense that they resemble the symptoms of a myocardial infarction.

It manifests itself in a similar way acute pancreatitis- inflammation of the pancreas located in the upper left part of the abdominal cavity. It is impossible to stop this life-threatening condition without urgent medical care.

A hernia of the esophagus is easy to recognize. Pain reminiscent of an angina attack usually occurs when the patient is in lying position, and become lighter as soon as he gets to his feet.

Gallbladder spasms, blockage bile ducts stones are also often manifested severe pain. Although the liver and gallbladder are located on the right, the pain in this case is girdle in nature and is given to the second side, to the region of the left hypochondrium.

Nitroglycerin is ineffective in all these diseases. Take off unpleasant symptoms help with antispasmodics and acid reducers gastric juice funds.

We all understand perfectly well what an important role in our body is assigned to such an organ as the heart, which is why even with the slightest discomfort in the left chest area, we feel a sense of anxiety and anxiety. However, in fact, you should not worry and panic for those who are visited by these unpleasant sensations for the first time or are extremely rarely disturbed. But those who regularly experience any pain in the region of the heart should be wary, because the repeated pain syndrome- there is evidence of the presence of any cardiovascular disease, which is of great danger and threatens your life. In this article, we will tell you about what cardiovascular diseases exist, as well as what needs to be done if your heart hurts.

Causes of pain in the heart

Vegetovascular dystonia. This disease is the most common cause of pain in the heart. essence vegetative dystonia- Violation of vascular tone of the autonomic nervous system. The symptoms of the disease are as follows: cardiopalmus, regular sweating of the palms and feet, tingling in the region of the heart, apathy and general weakness. Occurs spontaneously.

Attack of angina pectoris. This disease occurs as a result of atherosclerosis, the essence of which is as follows: cholesterol is deposited on the walls of blood vessels, which ultimately leads to vasoconstriction. Thus, our heart does not receive the amount of oxygen it needs, which causes pain in the heart. Symptoms of angina pectoris: compressive and pressing pain, which can also give to the left arm, shoulder and left side neck. There may also be numbness in the left hand. On average, an attack lasts 5-15 seconds.

Myocardial infarction. This disease is very dangerous and its essence is as follows: an acute circulatory disorder occurs, which is facilitated by the complete closure of the lumen of the vessel, which ultimately leads to necrosis or simply death of a certain area of ​​the heart muscle (myocardium). Symptoms of myocardial infarction are as follows: burning pain behind the sternum lasting more than 15 minutes, shortness of breath, severe weakness, excessive sweating. Untimely provision of emergency medical care can lead to death.

Various inflammations near the lying organs can also provoke pain in the heart area. Neuralgia of the intercostal nerves, pleurisy, myositis and pneumonia - all these diseases can simulate pain in the left region of the chest, since with all these ailments there is compression of nearby nerve endings.

Excessive alcohol consumption. We all certainly know about the dangers of alcohol, and it affects the heart in the first place. And the thing is that when alcohol enters the bloodstream, after a few minutes it causes the heart rate to increase significantly. Able alcohol intoxication the load on the heart increases many times: it has to "pump" huge volumes of fluid, which also contains toxic substances and alcohol. Undoubtedly, this procedure- overwork for our heart; as a result, it fails, which causes us pain in the heart and arrhythmia.

Stress. We are all familiar with such an expression as "all diseases are from the nerves." And this is true: the heart, like any other organ, is very sensitive to our nervous experiences. And the thing is that during stress, adrenaline is released into the blood, which, in turn, provokes constriction and spasm of blood vessels. All this leads to circulatory disorders and heart palpitations.

Hormonal disorders in women. During the onset of menopause, or during menstrual cycle in female body hormonal changes occur, in connection with which pains in the region of the heart may appear, which are of a different nature: they can be stabbing, pressing, tingling and squeezing.

Treatment of cardiovascular diseases

Of course, we all understand that with regularly occurring pains in the heart area, it is necessary to contact the appropriate specialist, and the sooner this is done, the better, because this is the only way to avoid complicated forms of diseases and, more importantly, save your life. For pain in the heart, you should contact a cardiologist or cardiac surgeon.

With any complaint of pain in the region of the heart, you without fail An ECG (electrocardiogram) will be scheduled. also in recent times to establish more accurate diagnosis, patients are assigned to undergo a stress ECG (velometry procedure, during which cardiac parameters are recorded during physical activity).

Phonocardiography (registration of heart sounds and murmurs) and echocardiography (examination of muscles and heart valves using ultrasonic waves) are also prescribed. There are other types of procedures, however, their passage is assigned on an individual basis, if necessary.

In order to exclude the possibility of the influence of any other organs on pain in the heart, patients are prescribed an examination of the spine by computed tomography and x-rays, and it is also recommended to visit such specialists as a neurologist, orthopedist and gastroenterologist.

What to do at home if your heart hurts

First of all, do not panic: as you already know, additional stress negatively affects the heart, which will only worsen your condition: with your experiences, you give your heart additional load in the form of a rapid heartbeat;

Try to change the position of the body: if the pain goes away when you change the position, know that you are definitely not in any danger; if, when changing the position of the body, the pain does not subside, and in some situations worsens, then these are signs of a disease such as angina pectoris;

Provide open access to fresh air: open a window or balcony;

Free your neck from constricting clothing: unbutton the top buttons or remove clothing that is squeezing your throat. Also loosen the belt;

Take advantage medicines: put a tablet of nitroglycerin or validol under the tongue, and also take 30-50 drops of valocordin or corvalol;

Take a sedative: motherwort infusion or valerian infusion can act as it;

If after ten minutes your pain has not gone away, put another tablet of nitroglycerin or validol under your tongue, take one tablet of aspirin and call an ambulance;

In a situation where your pain still subsided on its own, in the near future you are still strongly recommended to visit a specialist to undergo an electrocardiogram and pass all the necessary tests.

How to prevent heart pain

In order for pain in the heart area not to bother you, you need to constantly monitor your health and maintain your immunity. To do this, it is recommended to adhere to the following principles:

Give up bad habits: alcohol and smoking most negatively affect your heart;

Visit more often fresh air; walks before going to bed are especially important and useful;

Actively go in for sports: remember that your body should not be at rest;

Proper nutrition is the key to health; daily eat foods rich in potassium and calcium: bananas, potatoes, zucchini, beans, tomatoes, cottage cheese, dairy products;

Avoid fatty, fried and spicy food. It is best to give preference to boiled, stewed and steamed food. It is also worth giving up sweets and flour products, which also “clog” our body in every possible way, interfering normal operation of cardio-vascular system.

Providing first aid for pain in the heart:

First of all, the patient must be put on hard surface: on the floor or ground; on a soft pressure surface on chest completely ineffective;

Next, you need to do an indirect heart massage. For this, it is necessary to note desired point on the sternum: measure 2 fingers from the end of the sternum - this way you will find the location of the heart: just in the middle of the sternum;

Next, you need to do the following: take four breaths, and then alternate - 15 pressures on the sternum and 2 breaths - this is about 60-80 pressures per minute. Inhalation during indirect heart massage is done either from mouth to mouth, or from mouth to nose through gauze, which must be folded in two layers. The massage is done until the patient has a pulse and begins to breathe on his own.