ENGLISH PAPER MENOPAUSE AND CORONARY HEART DISEASE

RIZKI DIANTI FITRI 030.08.211

FACULTY OF MEDICINE TRISAKTI UNIVERSITY

PREFACE Assalaamualaikum Wr. Wb.

First of all, I would say million thanks to God ALLAH SWT who always watches over me in every time I breath. Then, hopefully the peace is always upon Mohammad, the Prophet who leads us to the truth so this English paper had been finished at the perfect time.

Second of all, I would like thanks to my parents for their love and support and also to Prof.Dr. Julius E. Surjawidjaja, Sp.MK. as my supervisor for his guidance and some critics to my articles so that I can finished it easily. For all my friends, I really appreciate their great time to accompany me and discuss the materials of the articles as long as I had difficulties in making this article. Last but not least, I realize to accomplish this assignment is far away from being perfect because of lack of my knowledge and grammatically language, so that I really need constructive critics to make it better. And hopefully this article is worth for all. Wassalaamualaikum Wr. Wb.

Jakarta, Juni 2012 Rizki Dianti Fitri

CONTENTS
PREFACE CONTENTS CHAPTER I : INTRODUCTION
1.1 1.2 1.3. 1.4 1.5. Background Problems Limitation of problems Objectives Method of writing

CHAPTER II : MENOPAUSE
2.1 2.2 2.3 2.4 2.5 2.6 Definition Etiology Epidemiology Symptomatology Diagnosis Therapy and treatment

CHAPTER III : CORONARY HEART DISEASE

3.1. 3.2 3.3 3.4 3.5 3.6 Definition Etiology Epidemiology Symptomatology Diagnosis Therapy and treatment

CHAPTER IV: THE CORRELATION BETWEEN MENOPAUSE AND CORONARY HEART Disease CHAPTER V: CONCLUSION

REFERANCES

Chapter I Introduction
1.1 BACKGROUND Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition. There are many factors can influence this condition. One of them is menopause. it is also called the change of life and defined as the end of the last menstrual period. The menopause occurs when the ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries fail to release an egg each month and to produce the female sex hormones oestrogen and progesterone. It is the fall in the levels of these hormones in the bloodstream that gives rise to the symptoms of menopause and makes metabolism disorder in the body . Men in their 40s have a higher risk of CHD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk. 1.2 PROBLEM According to the American Heart Association, cardiovascular disease is the leading killer of women over age 25. It kills nearly twice as many women in the United States than all types of cancer, including breast cancer. Only 13 percent of women think heart disease is a threat to their health. The misleading notion that heart disease is not a real problem for women can be blamed in part on medical research. For a very long time, heart disease studies have focused primarily on men. Changes are under way, but some doctors still fail to recognize the warning signs displayed by female patients.
Men are more likely develop coronary heart disease (CHD) than woman. After the age of 50 the difference between men and woman in the mortality rate from CHD diminishes until the age of 80 or more, when death rates from CHD are similar in both. Many have thought that young women are protected from CHD by ovarian hormones, and they lose this protection after the menopause, when concentrations of these hormones are reduced. If this werw so the rate whivh women die of CHD after difference between men and women in mortality from CHD to test the consistency with this and other hypotheses.

In this paper, I want to discuss about the correlation between Menopause and Coronary Heart Disease. The discussion about the definition until the treatments of the disease Coronary heart disease and the impacts of menopause on it. 1.3 LIMITATION OF PROBLEMS The topics that I will discuss in this paper are : What is Coronary heart Disease? What is Menopause? What is the link between Menopause and Coronary Heart Disease? How do we prevent Coronary Heart Disease in Menopause woman?

1.4 OBJECTIVES After reading this paper, the writer hopefully is successful on giving greater information regarding to the correlation between menopause and coronary heart disease. From this paper, we can get more information about menopause and its impact on coronary heart disease. Because this paper tells us about the definition, etiology, signs and symptoms, diagnosis, treatments, and prevention. 1.5 METHOD OF WRITING I look up these materials of menopause and coronary heart disease in some textbooks in the library. I also collect many information from journals and articles by using internet on-line.

CHAPTER II MENOPAUSE
2.1 Definition

Menopause is defined as the state of an absence of menstrual periods for 12 months. The menopausal transition starts with varying menstrual cycle length and ends with the final menstrual period. Perimenopause means "the time around menopause" and is often used to refer to the menopausal transitional period. It is not officially a medical term, but is sometimes used to explain certain aspects of the menopause transition in lay terms. Postmenopause is the entire period of time that comes after the last menstrual period. Menopause is the time in a woman's life when the function of the ovaries ceases.The ovary (female gonad), is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ovum) and female hormones such as estrogen. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. Estrogens also protect the bone. Therefore, a woman can develop osteoporosis (thinning of bone) later in life when her ovaries do not produce adequate estrogen.
2.2 Etiology

Menopause is a natural event that normally occurs between the ages of 45 and 55. Once menopause is complete (called postmenopause) and you have not had a period for 1 year, you are no longer at risk of becoming pregnant.
2.3 Epidemiology

The average age of menopause is 51 years old. But there is no way to predict when an individual woman will enter menopause. The age at which a woman starts having menstrual periods is also not related to the age of menopause onset. Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as the 30s or 40s or may not occur until a woman reaches her 60s. As a rough "rule of thumb," women tend to undergo menopause at an age similar to that of their mothers. Perimenopause, often accompanied by irregularities in the menstrual cycle along with the typical symptoms of early menopause, can begin up to 10 years prior to the last menstrual period.
2.4 Symptomatology

The symptoms of menopause are caused by changes in estrogen and progesterone levels. The ovaries make less of these hormones over time. The specific symptoms and how significant (mild, moderate, or severe) they are varies from woman to woman. A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. Hot flashes and sweats are at their worst for the first 1 - 2 years after the last period. Menopause symptoms may last 5 or more years. Estrogen levels may drop suddenly after some medical treatments, as is seen when the ovaries are removed surgically (called surgical menopause). Chemotherapy and anti-estrogen treatment for breast cancer are other examples. Symptoms can be more severe and start more suddenly in these circumstances. As a result of the fall in hormone levels, changes occur in the entire female reproductive system. The vaginal walls become less elastic and thinner. The vagina becomes shorter. Lubricating secretions from the vagina become watery. The outside genital tissue thins. This is called atrophy of the labia. Many women experience symptoms of the menopause and irregular periods for several years up to the menopause itself. This is called the climacteric, or 'perimenopause', and represents the gradual decline in the normal function of the ovaries. One of the common problems of the climacteric is that periods become erratic both in spacing and amount. Until the periods peter out all together, heavy bleeding can cause plenty of problems. In some women, menstrual flow comes to a sudden halt. More commonly, it slowly stops over time. During this time, the menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 - 3 years before menstruation finally ends completely. Before this the cycle length may shorten to as little as every 3 weeks. Common symptoms of menopause include:

Heart pounding or racing Hot flashes Night sweats Skin flushing Sleeping problems (insomnia)

Other symptoms of menopause may include:

Decreased interest in sex, possibly decreased response to sexual stimulation Forgetfulness (in some women) Headaches Irregular menstrual periods Mood swings including irritability, depression, and anxiety Urine leakage Vaginal dryness and painful sexual intercourse

Vaginal infections Joint aches and pains Irregular heartbeat (palpitations)

Diagnosis

2.5

Blood and urine tests can be used to measure changes in hormone levels that may signal when a woman is close to menopause or has already gone through menopause. Examples of these tests include:

Estradiol FSH LH

A pelvic exam may indicate changes in the vaginal lining caused by declining estrogen levels. The doctor may perform a bone density test to screen for low bone density levels that occur with osteoporosis. The rate of bone loss increases during the first few years after the last period.
2.6 Therapy and treatment

Medical treatment is available for women who are troubled by symptoms of the menopause such as hormone replacement therapy. Hormone replacement therapy (HRT) alleviates the symptoms of the menopause by adjusting hormone levels. It involves receiving a small daily dose of oestrogen. Women who have not had a hysterectomy are also given a progesterone-like drug as part of the HRT. This is called combined HRT. Combined HRT can be described as either sequential or continuous. Sequential combined HRT is suitable for women who are perimenopausal, ie still experiencing erratic menstrual bleeding. Most preparations are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which oestrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle. For women who are borderline postmenopausal and have very infrequent bleeds, there's also a sequential preparation available that results in three-monthly bleeds. Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of oestrogen and progesterone. There are some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure. Gabapentin is also effective for reducing hot flashes.

CHAPTER III Coronary Heart Disease

3.1. Definition

The heart is a muscle that is about the size of your fist. It pumps blood around your body and beats approximately 70 times a minute. After the blood leaves the right side of the heart, it goes to your lungs where it picks up oxygen. The oxygen-rich blood returns to your heart and is then pumped to the organs of your body through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation. The heart gets its own supply of blood from a network of blood vessels on the surface of your heart, called coronary arteries. Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma. If your coronary arteries become narrow due to a build-up of atheroma, the blood supply to your heart will be restricted. This can cause angina (chest pains). If a coronary artery becomes completely blocked, it can cause a heart attack. The medical term for a heart attack is myocardial infarction.
3.2 Etiology

Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and other substances form a plaque build-up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms, usually when you are active.
3.3 Epidemiology

Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. According to the American Heart Association, more than 15 million people have some form of the condition. Men in their 40s have a higher risk of CHD than women. But, as women get older, their risk increases so that it is almost equal to a man's risk.

Coronary heart disease (CHD) is the UK's biggest killer, around one in five men and one in seven women die from the disease. CHD causes around 94,000 deaths in the UK each year. In the UK, there are an estimated 2.6 million people living with the condition and angina (the most common symptom of coronary heart disease) affects 2 million people. CHD affects more men than women, and your chances of getting it increase as you get older.
3.4 Symptomatology

Symptoms may be very noticeable, but sometimes you can have the disease and not have any symptoms. Chest pain or discomfort (angina) is the most common symptom. You feel this pain when the heart is not getting enough blood or oxygen. How bad the pain is varies from person to person. There are two main types of chest pain:

Atypical chest pain -- often sharp and comes and goes. You can feel it in your left chest, abdomen, back, or arm. It is unrelated to exercise and not relieved by rest or a medicine called nitroglycerin. Atypical chest pain is more common in women. Typical chest pain -- feels heavy or like someone is squeezing you. You feel it under your breast bone (sternum). The pain usually occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.

Women, elderly people, and people with diabetes are more likely to have symptoms other than chest pain, such as:

Fatigue with activity (exertion) Shortness of breath Weakness

Diagnosis

3.5

Many tests help diagnose CHD. Usually, your doctor will order more than one test before making a definite diagnosis. Tests may include:

Coronary angiography/arteriography -- an invasive procedure designed to evaluate the heart arteries under x-ray CT angiography -- a noninvasive way to perform coronary angiography Echocardiogram Electrocardiogram (ECG) Electron-beam computed tomography (EBCT) to look for calcium in the lining of the arteries -- the more calcium, the higher your chance for CHD Exercise stress test Magnetic resonance angiography Nuclear scan

3.6

Therapy and treatment

Treatments for coronary heart disease (CHD) may include lifestyle changes, medicines, and medical procedures. The goals of treatments are to:

Relieve symptoms. Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque. Lower the risk of blood clots forming. (Blood clots can cause a heart attack.) Widen or bypass clogged arteries. Prevent complications of CHD.

Lifestyle Changes Follow a Healthy Die. A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help maintain a healthy weight. Therapeutic Lifestyle Changes (TLC). TLC may be recommended if you have high blood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management. With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods. No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats. You also should have less than 200 mg a day of cholesterol. Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:

Whole-grain cereals such as oatmeal and oat bran Fruits such as apples, bananas, oranges, pears, and prunes Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber. A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week. You also should try to limit the amount of sodium (salt) that you eat. This means choosing lowsalt and "no added salt" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item. Try to limit drinks that contain alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor. Dietary Approaches to Stop Hypertension (DASH).

The DASH eating plan may be recommended if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium. DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber. The DASH eating plan is a good healthy eating plan, even for those who dont have high blood pressure.

- Be Physically Active
Routine physical activity can lower many CHD risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight. Physical activity also can lower the risk for diabetes and raise HDL cholesterol level. HDL is the "good" cholesterol that helps prevent CHD.

- Maintain a Healthy Weight

Maintaining a healthy weight can lower the risk for CHD. A general goal to aim for is a body mass index (BMI) of less than 25. BMI measures the weight in relation to your height and gives an estimate of total body fat. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for preventing and treating CHD.

- Quit Smoking
Smoking can raise the risk for CHD and heart attack and worsen other CHD risk factors. If they have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

- Manage Stress
Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting eventparticularly one involving anger. Also, some of the ways people cope with stresssuch as drinking, smoking, or overeatingaren't healthy. Learning how to manage stress, relax, and cope with problems can improve the emotional and physical health. Physical activity, medicine, and relaxation therapy also can help relieve stress.

Medicines

Medicines may needed to treat CHD if lifestyle changes aren't enough. Medicines can:

Reduce hearts workload and relieve CHD symptoms Decrease chance of having a heart attack or dying suddenly Lower cholesterol and blood pressure Prevent blood clots Prevent or delay the need for a procedure or surgery (for example, angioplasty or coronary artery bypass grafting (CABG))

Medicines used to treat CHD include anticoagulants such as aspirin and other anticlotting medicines, ACE inhibitors, beta blockers, calcium channel blockers, nitroglycerin, glycoprotein IIb-IIIa, statins and fish oil and other supplements high in omega-3 fatty acids.

Procedures and Surgery

A procedure or surgery may needed to treat CHD. Both angioplasty and CABG are used to treat blocked coronary arteries.

1. Angioplasty
Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called percutaneous coronary intervention, or PCI. A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps prevent blockages in the artery in the months or years after angioplasty.

2. Coronary Artery Bypass Grafting

CABG is a type of surgery. In CABG, arteries or veins from other areas in the body are used to bypass (that is, go around) your narrowed coronary arteries. CABG can improve blood flow to the heart, relieve chest pain, and possibly prevent a heart attack.

3. Cardiac Rehabilitation
Almost everyone who has CHD can benefit from cardiac rehab. Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems. The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists. Rehab has two parts:

Exercise training. This part helps you learn how to exercise safely, strengthen the muscles, and improve the stamina. An exercise plan will be based on personal abilities, needs, and interests.

Education, counseling, and training. This part of rehab helps understand the heart condition and find ways to reduce the risk of future heart problems. The rehab team will help to learn how to cope with the stress of adjusting to a new lifestyle and deal with your fears about the future.

CHAPTER IV

THE CORRELATION BETWEEN MENOPAUSE AND CORONARY HEART DISEASE In the past few decades, it has become very apparent that cardiovascular disease has become the leading cause of death in women over fifty years of age. Recently, it has been discovered that certain occurrences during menopause, have an impact on the development of heart disease. The increase of certain fats within the blood, can lead to cardiovascular problems. However, women who have a family history of heart diseases, or a previous blockage, will be at greater risk. During menopause, the fat levels within a womans blood will increase. The fats are called lipids, and cholesterol levels are calculated by determining the number of lipids in a unit of blood. There are two specific types of cholesterol that can affect the development of heart disease. These types are HDL and LDL. HDL, or high density lipoprotein, is beneficial. It works to clean the blood and eliminate excess fat. However, LDL stands for low density lipoprotein. This component works to make fat stick to the walls of the arteries, within the body. When this fat causes the passageway to become blocked, a heart attack can occur. After menopause, many women develop an increase in LDL levels and a decrease in HDL. Therefore the blood vessels can often become blocked. These increases and decreases are thought to occur due to a lack of the hormone estrogen.

CHAPTER V: CONCLUSION

To be olderly is not a pathology problems. It is a normally of fisiology body humans. Every women will get the symptoms of menopause with the different etiologies. Menopause will be decreased the systems of our body, especially for women. So, from that paper to be a healthy women with menopause condition, we must be do prevention from now. There is not to late to do prevention. Changes your bad habbits, be active person, control our foods and drinks, etc. So from that, we can reduce the bad effect like coroner heart disease. And the last but not least, the best treatment for heart disease with menopause is prevention. Early and continued prevention can help all women avoid heart disease and its consequences. Maintaining a healthy diet that is low in fat can help prevent your arteries from clogging, especially after menopause. Reducing the amount of alcohol you drink and avoiding cigarettes can also reduce your risks of high blood pressure and help in your heart disease prevention efforts.

REFERANCES Health Howtuffworks, available at http://health.howstuffworks.com/wellness/women/general/coronary-heart-disease-riskfactors-in-women1.htm Accessed June 10,2012 Epigee, available at http://www.epigee.org/menopause/heartdisease.html Accessed June 10,2012 The JAMA Network, available at http://jama.jamanetwork.com/article.aspx?volume=283&issue=14&page=1845 Accessed June 10,2012 C.Health, available at http://chealth.canoe.ca/channel_condition_info_details.asp? disease_id=39&channel_id=2045&relation_id=33253 Accessed June 10,2012