>>This is Francis Morrison, I'm going to give a series of lectures called Very Mini Med School, and it will 
be descriptions of common diseases and conditions.  My background is in medicine and public health 
as well as informatics with Masters Degrees in Public Health and Biomedical Informatics and training at 
the New York City Health Department, as well as the Columbia University Department of Biomedical 
Informatics.  
My goal, in these lectures, is to give people who don't have a clinical background a language to use 
when communicating with clinician, as well as to understand some of the elements that they'll find in 
an electronic health record.  The objectives of this lecture and the next two lectures after this are to 
know the common diseases and conditions in the United States, centered around the most common 
causes of death, as well as understand some basic physical processes related to the conditions.  Some 
essential data elements that they'll find when encountering these conditions in a health record, and 
some lab, radiology and clinical finding data, related to conditions and what those mean.  
As I mentioned, I'm centering the discussion of medical terms and medical concepts around the top 
ten causes of death in the United States and these are the top ten including heart disease, cancer, 
stroke, lower respiratory diseases, accidents, Alzheimer's, diabetes, lung infections, like influenza 
pneumonia, kidney disease, such as nephritis, nephrotic syndrome and nephrosis, as well as 
septicemia.  I'm only going to be discussing some of these that you see with asterisks because they 
tend to get fairly redundant and you can understand a lot of the main concepts, just around those six 
that I am going to discuss.
The first disease I'm going to discuss is heart disease.  The term heart disease is very broad and can 
encompass many different conditions and diseases involving the heart.  I'm going to talk about two 
main ones, which is heart attack or coronary artery disease, as well as congestive heart failure or heart 
failure.  You can see the anatomy of the lungs and the heart, where the heart is positioned between 
the two lungs.  I have highlighted the areas where early symptoms of heart disease can show up, 
which is having fluid in the lungs or the extremities, as well as, chest pain.  
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The physiology of the circulatory system, which consists of the heart and blood vessels can be thought 
of as a figure 8, where the heart pumps blood through arteries to the extremities and organs, which 
travels back to the heart through veins and is then pumped out again to the lungs to pick up oxygen, 
through arteries and back to the heart through veins.  The left side of the heart controls or pumps 
blood to most of the organs, including the brain, kidneys, liver and the extremities, the right side of 
the heart pumps blood to the lungs.  What happens when the heart fails is that, first of all, the arteries 
are not carrying the oxygenated blood to the organs that need it, so that you can have decreased 
oxygen in various organs, of which the brain is particularly sensitive.  The other thing that happens is 
that the blood does not return properly, so there's a backup that goes all the way to either the lungs 
or the extremities, depending on which side of the heart is not functioning properly, so that results in 
a fluid buildup called edema, that can either happen in the lower legs or the lungs.
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Heart disease or coronary artery disease is caused by a narrowing of the arteries that feed the heart.  
This is very important because the heart is a muscle that needs a lot of oxygen and when the arteries 
are narrowed, less blood, and therefore, less oxygen are able to feed those muscles and they start 
being damaged.  Heart muscle cells do not divide very quickly, they don't repair themselves very well, 
so any heart damage tends to cause scaring and long-term lack of functioning.  You can see the 
coronary arties on the left, that come straight off of the aorta, which is the largest artery in the body, 
and curves over the top of the heart, as you can see.  The narrowing of the vessels is caused by some 
amount of damage, followed by fatty deposits and scarring in the inside of the blood vessel or the 
lumen, which can result in either any piece of material getting stuck inside that lumen and stopping the 
blood flow or narrowing to the point where the muscle is not getting enough oxygen.  
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Some of the terms you'll see in a patients record, related to heart disease include, cardiac disease, 
coronary artery disease, atherosclerosis, which is a fatty deposit in a blood vessel, arteriosclerosis, 
which is scarring of the arteries, or narrowing of the arteries, angina is chest pain due to damage to the 
heart muscle, congestive heart failure is when the heart is functioning poorly and congestion or build 
up of fluid occurs in the lungs, which is also pulmonary congestion, and edema is simply swelling 
caused by the fluid buildup, usually referring to the extremities.  You can see that I circled one of the 
main word roots, word roots in medicine are very important.  They can give you a clue what meanings 
of words are, even if you've never seen the word, so a major word root is cardiac, which actually is 
Latin for heart.  Another.
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The word root athero means fatty, so atherosclerosis is fatty deposits and scaring, and that can refer 
to either arteries or veins, although it's more common in arteries.  Arteriosclerosis is scaring of the 
arteries, so the word root artery means, the word root arterio means artery, and sclerosis, as I 
indicated earlier, just means scaring, so there are other phrases like scleroderma is a disease where 
derm or skin is scared, so sclero is a term for scar.  You'll see the word root pulm a lot, which refers to 
lung, so pulmonary congestion is congestion of the lungs.  
Heart disease is associated with increasing age, not surprisingly, also family history, smoking is a large 
contributor to heart disease, hypertension or high blood pressure, as well as high cholesterol, can be 
responsible for the fatty deposits in arteries, as well as diabetes, and some of these I will cover in later 
lectures.  
Prevention and treatment of heart disease include exercise and diet, as well as medication, such as 
blood thinning medications, like aspirin is one that causes fewer clots, that would potentially stop the 
blood flow in coronary arteries, as well as cholesterol lowering, blood pressure lowering medications.  
Angiogram and Angioplasty are major treatments for heart disease.  An angiogram in when a tube is 
placed in the blood vessel, usually through the leg, and its snaked up through the coronary arteries 
and dye is released and watched on a, basically, a moving x-ray, so you can see where the narrowing 
occurs, and then, usually, that's followed by angioplasty, which is a widening of that areas that's 
narrowed, through the same, using that same type of tube.   Surgery can also be done, so you may 
have heard the term cabbage or coronary artery bypass graft, where they literally just take other 
blood vessels and put it around that area of narrowing to make that the blood is getting to the muscle. 
Labs you'll see a lot when a person has heart disease include, a cardiac panel, chemistry panel, CBC or 
complete blood count, and clotting test, and I'll go into each of these labs in a little more detail.  
Generally, the cardiac panel is to detect damage to the muscle cells.  Chemistry panel is to determine 
whether the electrolytes are normal in the blood.  A complete blood count looks at the cells in the 
blood to see if they are at the normal levels.  And, clotting test, the purpose is to find how fast the 
blood is clotting.  People who have heart disease will get a lot of chest x-rays to look at whether there 
is fluid in the lungs or if the heart is enlarged.  And electrocardiogram, which is shortened at EKG, 
sometimes ECG, is a, basically, a diagram of the electrical movement through the heart.  The heart 
knows to pump by an electrical pulse, so there's an electrical pulse followed by pumping of the heart 
and if the diagram or the outline of the EKG is abnormal, you can see that there is damage or scaring or 
lack of muscle function in certain areas.  An echocardiogram is an ultrasound of the heart that can look 
at blood flow and see if it's flowing normally.  And, an angiogram I described earlier, is another test to 
see if there is narrowing in the coronary arteries.  
You can see the word root gram is just a picture, so an electrocardiogram is a picture of the electricity 
running through the heart.  Angio means blood vessel, so an angiogram is, again, a picture of the 
vessels of the heart.  
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As I discussed, I'm going to go through several of the labs that are common in medical records.  The 
first one I'm going to discuss is a cardiac panel.  The premise for cardiac panels is that, when heart cells 
or heart muscle cells are damaged, they release specific components that only the heart has, and 
these can be detected in the blood, by lab tests, and two of these lab tests that are very common are 
CKMB, which is creatine kinase type of material found in the muscle cells of the heart, as well as 
troponin, these typically are run in multiple series to see if the heart damage is increasing or 
decreasing and these can often be delayed so that the damage is only detected several hours after 
the heart damage occurs.
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The next disease I'm going to talk about is cancer.
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As you can see, cancer can occur in many different parts of the body.  I've listed the top ten causes of 
cancer in the United States including lung, breast, kidney, colon, ovary.
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The basic physiological process of cancer is that cells divide out of control.  This happens when DNA is 
damaged, the DNA is the basic instruction set in each cell, and it has regulations on how rapidly a cell 
divides.  So, for example, skin cells divide fairly rapidly.  You get a new layer of skin cells every day or 
so, and that occurs by the bottom most layer of those skin cells dividing.  If the DNA is damaged, then 
these cells don't know to stop dividing and they start replicating out of control, which uses up all of the 
nutrients and oxygen, and the resources needed for functioning cells around it to work, which is why 
that ends up being harmful to a person's health.  
Some related terms you'll see surrounding cancer include DNA, carcinoma, carcinogen, which is a 
cancer causing substance, carcinoma is simply another  way, thin cancer, malignant, which is a term 
that mean cancerous specific to whether a tumor is benign or malignant, so there can be benign 
tumors or masses, but a malignant tumor is always a cancer. Oncology is the area of medicine that 
addresses cancer issues.  Metastasis is when cancer cells leave their original site and move through the 
body and start growing somewhere else, very common areas of metastasis are where there is a lot of 
blood flowing through, including the liver and lungs, are common sites for metastasis.  And, screening 
is the detection of cancer early in its course.  
An important word root, again, is carci or carcon, which means a cancer.  Oma is simply a growth, so 
you can an oma of anything, so a lymphoma is a growth of the lymph system or lymph node.  
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Ectomy is removal, a lumpectomy is removal of a lump.  You can have a splenectomy, which is a 
removal of the spleen.
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Causes of cancer include increasing age, where you have more DNA damage over time, as well as 
genetics, or family history;  some DNA's predisposed to being damaged and causing cancer.  Smoking is 
a cause of many different types of cancer, especially lung, throat and others.  Diet and environmental 
toxins or exposures can also result in cancer.  
Prevention and treatment include behavior change, so especially smoking cessation or stopping 
smoking.  Chemotherapy is very common treatment for cancer.  Chemotherapy medications stop cells 
dividing, which is why people lose their hair, because the way the hair grows is the cells divide, and 
they're very rapidly dividing cells, so when somebody has chemotherapy, those cells stop dividing and 
the hair falls out.  Surgery is another treatment for cancer, so ectomy, as I said, a splenectomy or a 
lumpectomy is the physical removal of a growth.  And, radiation is the focused ablation or destruction 
of cells, using radioactive substances.  
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The labs you'll see in patients who have cancer include chemistry panels, complete blood count, blood 
smear is when a pathologist looks at a sample of blood through a microscope to determine whether 
there are any abnormal blood cells. There are also specialty screenings, including BRCA, which detects 
whether an individual has the gene that predisposes them to breast cancer, as well as PSA, which is 
Prostate Specific Antigen, that can detect growth of the prostate, sometimes indicating cancer.  
Related tests you'll see in cancer are x-ray, MRI, which is Magnetic Resonance Imaging, CT, which is 
Computed Tomography and Nuclear scans, and I'll also describe some of those in a little more detail 
later.  A very common lab, that you'll see in individuals with cancer ,includes liver function tests, or 
LFT's, because the liver is a very common site for Metastasis, as I described earlier.  The labs that are 
included in this series include albumin, which is a substance made by the liver, so you can tell if the 
liver has damage, the albumin will be decreased.  ALT and AST, and you probably don't never need to 
know the actual terms that those refer to, but they're both substances that come from the liver that 
demonstrate whether the liver has damage, just like the cardiac panel will show if the heart has 
damage.  Alkaline phosphatase is another liver damage indicator and bilirubin is a  substance made by 
the liver that will demonstrate whether the liver is damaged or working properly.
In summary, we reviewed physical process related to heart disease and cancer, and some essential 
data elements you would see in an electronic record related to those conditions, and some of the lab, 
radiology and clinical findings, that you would find in patients with heart disease and cancer.  
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