Cardiac tomor

Cardiac tumors are a serious condition regardless of the pathological findings of the tumor, i.e., benign or malignant.

A practical diagnostic approach to cardiac diseases includes history taking, physical examinations, blood analysis, chest radiography, and electrocardiography. However, these techniques may not be useful in make a diagnosis of cardiac tumors. Needless to say, echocardiography is at the top of the list that should be considered among patients with cardiac tumors.

Let me show you an example.

I did not think that the patient would have a cardiac tumor until echocardiography was performed for sinus tachycardia. As the proverb goes, a picture is worth than a thousand words. Once in a while, the same goes with the field of medicine.

Echocardiography says, "Seeing is believing."

No hangover

I was wasted yesterday because I drank a lot, but I have no hangover right now.

Last night, my colleagues and I attended a scientific meeting, which is held twice a year, late fall and early summer. We had six speeches in the conference, with almost good results. Not to mention, we were content with our performance because hard work had been done for it.

After the meeting, we had a big meal at Izakaya or a casual restaurant. Wonderfully, the Izakaya was all we can eat and drink for three hours at a reasonable price, almost $40 per person.

After drinking tons of beer and Japanese sake, we moved to another barbecue restaurant and drank more. Nonetheless, I got up as usual and found myself without hangover.

Do you wanna know the secret?

I ate a rice ball in advance. Eating something small before start drinking is a good way for me to avoid having a hangover next day. It is simple but surely effective, I guess. Give it a try.

The sixth sence

I was tired that night, and went to bed at around 10:30 pm.
All of a sudden, something like a bleeze passed through my ears from the right to the left, when I have almost fallen asleep.

I got up and checked my cell phone, alarm clock, pillow and futon, but found nothing changed from before. Not to mention the windows or door in my bed room were closed. Suddenly, my patient, who has been in a serilusly critical condition and receiving palliative care, came to my mind for no specific reason.

A few minutes later, my phone rang, saying "Sorry to bother you, Doctor, but your patient's heart rate suddenly dropped." The patient died 10 minutes or something after the phone call.

I think that I am a scinentific person, and did not believe the sixth sence.
From now on, I may have to admit that there are many things that are scientifically unexplained.

Way to go!

The Circulation is the most influential journal in the field of cardiology. Publishing an article in Circulation could be a dream, although extremely tough, among cardiologists all over the world.

Today, I have got good news. Guess what? Our manuscript has been accepted for publication in Circulation. You may not believe it, but the first author of the article is a resident doctor, who graduated from medical collage just 5 years before. Congratulations!

The article is not a full-length research paper, but kind of a case report with impressive images. However, the value of the manuscript will not be reduced because the originality of her study is exceptional. Detailed physical examinations by this young, female doctor has made our dream come true. I am really proud of her and her work.

I would like to have a big dinner with her tonight. Of course, I will buy the dinner to her. Not to mention she absolutely deserves it. One sad thing is she is now in India for a vacation, and has not known this good news yet.

I hope that she is enjoying an offline life, sitting close to the Taj Mahal, a well-known white marble mausoleum.

Nuclear cardiology

Let me show you one medical image. What do you think it is?

This beautiful picture is what nuclear cardiology is like. Doctors can assess the presence or absence of myocardial ischemia as well as myocardial infarction if they are an expert in the filed of nuclear cardiology. On top of that, the extent and severity of myocardial damages, if any, can be assessed.

I would say, however, there are many cardiologists who are not good at this filed, although nuclear cardiology is very useful in making a decision among patients with known or suspected ischemic heart disease. Some fuzzy features exist on nuclear cardiology, which seems to make doctors stay away from this category.

Another problem is that it takes a while (e.g., 4 hours) and costs a lot (e.g., $700) to undergo nuclear cardiology.

Futon

I had not known that the word "futon" is an English word until I looked it up on my online dictionary.

The fact that Wikipedia has a page to explain futon in English surprised me.

A futon is a traditional blanket that is used in Japan when we sleep. It makes us feel warm and promises a comfortable night. I love a bedtime with a few layers of futons, especially in winter, because it is freezing cold in Japan. You may recommend that I can use a heater instead of futons, but I do not like using heaters while sleeping. All night heaters sometimes make me feel uncomfortable in the throat when I get up.

I tried wearing a mask with heaters, but no improvement was obtained because I felt I could not breathe well during sleep. Such a kind of problem can occur when I stay at a hotel.

Heart sound and position

Heart sounds vary depending on where a stethoscope is placed.

Let say, if you put a stethoscope on the apex of the heart, the first sound (S1) is louder than the second heart sound (S2). On the other hand, S1 becomes smaller than S2 when the stethoscoep is moved to the basal part of the heart.

Easier to hear than to read. Click musical notes below and get it.

Apical heart sound:  ♪♪♪
Basal heart sound:  ♪♪♪

This rule is simple and easy to master, but surprisingly, many doctors ― even some cardiologists ― know next to nothing about the balance between S1 and S2. To be more precise, they had learned at medical callage, but has forgotten it.

Kujibiki

Kujibiki is a kind of lottery and very popular among kids in Japan.

The rule is very simple. First, you pay a small amount of money, such as one dollar. Second, you pick up one piece of folded paper in a box where there are many pieces of folded paper. Third, you open the paper and check the number written on it. Finally, you can get a gift according to the number that you got.The numbers are usually form one to one hundred; the smaller the number, the better the present.

The left picture is what my daughter got on Kujibiki at a local festival yesterday. Her number was two although her little brother got almost No. 100. What she got, a bag of one of Disney characters, has been attracting her recently. I was very happy to see my daughter excited.

When it comes to Kujibiki, I think that she is always lucky, as is her mother. It seems like good lucks run in the women of my familiy. That means I am lucky as well, because I am always close to them.

Old coins

When I was a kid, what I really loved was to collect old Japanese coins. But I have forgotten it for a long time.

The other day, my younger son found a small, wooden box in the storage. He came to me and asked, "Daddy, what's that? Can I open the box?"

The first glance of the old box reminded me of my old hobby (i.e., coin collection). This box was my treasure. I opened the box, checked many coins, and closed the box － that was my routine at that time.

My son and I opened the box for the first time in decades. What surprised me was I still love old coins. They varied in terms of shapes and materials; a round or square shape: silver, copper, or gold: small or big ones.

Unexpectedly, my son was not interested in these old coins. This may be because he cannot get candies with the old coins.

JS Bach

I cannot get enough of music composed by JS Bach.
Actually, listening to Bach, I am writing this blog right now.

Bach made a wide range of classical music, from piano to violine. Among them, piano works are what I have been attracted most.

Bach is a really great composer as well as an educator. However, Bach may remain you that you had been forced to play his piano music, such as the Inventions and Symphonias, to improve your piano skills as a child. That made some people dislike him, I geuss. It would take a while to understand the value of Bach; I found myself fascinated by Bach after I turned thirty.

The Goldverg vriations are one of my favorite music written by Bach. This wonderful piano piece starts with a lovely small aria, followed by a set of 30 variations, and ends with the peaceful aria again. The exceptional creativity based on mathematical methods is beyond my imaginations.

If you give it a try, I recommend the Gordlberg variations played by Glenn Gould. The eccentric Caniadian pianist recorded this piano piece twice, in 1956 and 1981, and both are excellent.

My dream is that the Goldberg Variations played by me is released during my golden years.

Color Doppler

Non-medical people would think that echocardiographic images are always black and white, but it is not true. Please take a look at a video below.

The right panel shows the same image as the left panel with color data. You can see blue and red flows by color Doppler. These colorful signals are not bloodstream themselves but reflect the direction of blood flows in the heart.

Red signals indicate blood flow toward the echocardiographic probe, which is located at the top of an image. On the other hand, blood flow away from the probe is shown in blue. This rule of the color mapping on echocardiography is universal.

Who discovered this color Doppler technique? The answer is two Japanese guys, an expert engineer and a cardiac surgeon (Omoto R, Yokote Y, et al. Jpn Heart J. 1984;25:325-40).

I am very proud of the discovery by the Japanese, but few know about it even if they are Japanese medical staff in the filed of cardiology.

Great Wall

I have been to Great Wall of China when I was in college.
It moved me because the Great Wall was too long to imagine how long it would be.

The Great Wall is located in the northern part of China and, no doubt, the longest structure in the world. It is said that the length is more than 7000 km, which is longer than the Japanese archipelago. Wonderful. I cannnot imagine how long it took to create.

I have heard that the Great Wall is the only human-made construction that can be seen in the universe. I thought it would make sense because it is incredibly humongous. However, a podcast I listened to the other day said that it is a common myth. Actually, it seems like nobody can see the Great Wall from outer space.

I am still wondering if it is true or false.

I am looking forward to receiving the answer from an astronaut who happens to read my blog in the International Space Station or ISS.

A canned coffee

I do not think I am a coffee person, though I drink several cups of coffee every day at work.

Studies show that drinking coffee is associated with a longer life. Maybe coffee is effective in reducing stress. Green tea seems to have the same benefits. In addition to such a relaxing effect, to avoid getting dehydrated is likely to be affecting favorably in terms of life expectancy.

There are so many vending machines in Japan, and you can get cold or hot beverages, such as coffee and green tea, at a reasonable price (almost 1 dollar). It is very convenient but I seldom get something to drink from vending machines during work. I take advantage of free drinks provided at my office. This is not only for saving money but also for saving energy.

Although vending machines used to be a high energy consumer, the electric bill of a vending machine is currently reported to be a quarter as much as 10 years. This technological advances, however, do not justify a waste of electricity. Japan, where I was born and raised, is a really small country with little natural resources.

This canned coffee, as shown above, is a small gift for me since I have done a good job at work.

" "

Can you see the title of my blog? I guess you cannnot.
Today's tilte is " " not but only quotation marks.

I did write " " on the title but it never appears.
I really hate "  ".

You may think that " " is a typo or funny characters related to fonts, but that's not true. This is a code used on a computer language (hyper text markup language, HTML), and means adding one space in a text.

Let me show an example.
Sample A: "I am the best blogger."
Sample B: "I am the best blogger."

Joking aside, both of the samples A and B have the same meaning on HTML. I am sure the former looks more natural than the latter. However, it does not seem to matter to computers. They have no feeling (so far), and never mind things like that as long as codes are written correctly according to the rule of HTML. Do you like the way that computers like, just like rule is everything?

The "nbsp" stands for Non-Breaking SPace. To be honest, I did not know that, but Google taught me as usual.

We have to keep in mind, Google website is also working on this HTML rule.

A heart sound

Have you ever heard of heart sounds?
I am not talking about the voice of the heart but sounds that the heart makes physically.

Here is a normal heart sound. ♪♪♪ (click to hear)

I recommend that you listen to the sound with earphones jammed in tight. PC Speakers would not work well in terms of the reality. Sorry about the back ground noise but this is a real heart sound that doctors listen to with a stethoscope in dairy clinical practice.

Heart sounds are basically composed of two elements, the first and second sound. If your heart sounds have more components other than the first and second sound, you should go see your physician because an additional heart sound may be associated with heart problems.

Interestingly, the third heart sound is common among healthy children and adolescents, called "physiological third sound". The third sound disappears in their twenties and can appear later when you suffer from heart diseases, for example heart failure.

Benz and BM

Here is a short dialogue between Taro and John.
Taro is an English learner and John is his English teacher.

Taro: "I'm really into cars."
John: "I love automobiles, as well."
Taro: "Auto...? Anyway, I have a Benz and a BM."
John: "Oh, you have a Mercedes and Beemer."
Taro: "Mer...Bee...? English is difficult."

There are many automakers in Japan. Google says more than 25: Toyota, Honda, Mazda, Nissan, Subaru, Mitsubishi, Suzuki, Hino, Isuzu, Daihatsu, Fuso, UD Trucks, Mitsuoka, ElecTrike Japan, Dome, Takeoka, etc.

I am wondering if these Japanese automakers are also called differently outside of Japan.

Valsalva aneurysm

An aneurysm of the sinus of Valsalva is a rare condition defined as a dilation between the aortic valve and the sinotubular junction.

This disease used to be diagnosed after the rupture of an aneurysm, but recently, unruptured aneurysms of the sinus of Valsalva appear to be detected incidentally by imaging modalities.

Below is three-dimensional CT images of an unruptured Valsalva aneurysm.  You can see a sack-like structure attached to the right coronary cusp; three arteries are the right coronary artery, the left anterior descending artery, and the left circumflex artery.

Surgical repair is recommended for a ruptured Valsalva aneurysm, but the optimal treatment remains unclear among asymptomatic patients with an unruptured aneurysm.

Surprisingly, most of Valsalva aneurysms are congenital although some are acquired, e.g., trauma or infection. It would take several decades for a tiny pouch to glow up.

Patient's words

Here is a dialogue between a doctor and patient.

Patient says, "Recently, I've had chest discomfort, doctor."
Doctor asks, "I see. When does it happen?"
Patient answers, "It occurs while jogging or walking briskly, but not watching TV."
Doctor says, "I'd like to take an electrocardiogram to check your heart."

Several minutes later...

Patient asks, "How was the result, doctor? Is there something bad?"
Doctor replys, "The electrocardiogram is completely normal."
Patient says, "What a relief! I thought I might have heart problems."
Doctor adds, " Don't worry too much about it."

Do you think this doctor has the ability to make a diagnosis among patients who have chest symptoms?

Of course not!

In the management of angina or ischemic heart disease, normal findings on electrocardiography, echocardiography, chest radiograph, and blood examinations do not always guarantee health. I believe what we should pay attention to is to take a careful medical history.

Sir William Osler, one of the best-known physicians, said, "Listen to your patient, he is telling you the diagnosis."

A blend word

"It's fantabulous! Really humongous," said Mr. A.

It goes without saying that fantabulous means fantastic and fabulous, and humongous is huge and monstrous. These blend words are effective in enhancing what you are talking about, such as the size or wonderfulness. The rhythmical sounds of these words are another reason why blend words are quite popular especially among teenagers.

Have you ever heard of "KIMO-KAWA"? It is a blend word in Japanese. I have never heard of it before, but young girls are likely to use this slang word. It is a combination of "Kimochiwarui" or creepy in English and "Kawaii" or cute. Then, "KIMO-KAWA" refers to something creepy and cute.

Does my explanation make any sence?
Can you imagine anything creepy but cute? I am wondering what in the world it is.

I asked Google - Here's the answer.

Heart rate

How would you react if you knew that your heart beats are a countdown to death?

Basically, the number of heart beats in the life span of each animal is almost determined. The upper limit is estimated to be about 1.5 billion times per life in most animals. Mice have an average heart rate of 600 beats per minute and a life span of 5 years or shorter, whereas elephant's heart rate is 20-30 beats per minutes at rest and their life spans are as long as 50-80 years.

The same rule is also applied to human beings, although the total count of heart beats can double probably because of clinical medicine and public health. There is statistical evidence showing that those who have a lower heart rate can live longer than those who have a higher heart rate.

The point is that a life span might be expected on the basis of heart rates, to some extent.

Of course, aside from a heart rate, there are many determinants of life span, such as comorbidities, geographic location, gender, socioeconomic status. However, if you have a higher heart rate at rest, e.g., 100 beats per minute or more, you might as well go and see a physician. Something unfavorable may be hidden regardless of whether you are symptomatic or not.

Do not worry too much if your kids have a higher heart rate. Children's hearts are always beating with a lot of energy.

Rosso corsa

Ferrari, an Italian sport car, goes well with rosso corsa, which means racing red in Italian. It is said that rosso corsa is the national racing color of Italy. So many guys like Ferrari painted rosso corsa, so do I, although not affordable.

You can see a red panel below. How do you feel about this color?

You would say it is a tinge of red, compared with rosso corsa. Believe it or not, this is a photo of the wall of my house. Don't you think it looks weird? Have you ever seen such a fun-colored house?

My wife and I had the house built several years ago. The house was supposed to be painted beige but our choice was not available for some reason. We decided to paint the wall red, which had nothing to do with rosso corsa.

My wife was frightened to initially see the house painted red and called me at work, because the color had a stronger impact than she expected. In order to check it, I left my office and rushed to our house under construction. What I told to my wife was "what a beautiful color it is.", making her feel relieved, she said later.

To be honest, I was also a little shocked to see the vivid color but I pretended I liked it at that time.
It was not long we got used to the color. Now I can assure you that it always relaxes me.

Angina

I am wondering if most people are familiar with a word, angina or angina pectoris.

Angina is a medical condition associated with myocardial ischemia, and commonly develops on exercise but can occur even at rest. During an attack of angina, you feel discomfort in the chest.

Most people, including medical staff, consider chest pain a typical symptom in patients with angina, but it is likely to be a stereotypical misunderstanding. According to my patients who are diagnosed with angina in my hospital, the symptom is different form chest pain. They say it is not painful but oppressive; it could be expressed as a toothache or headache in some cases. Remember, symptoms associated with angina vary depending on the patient.

My recommendation is that you do not have to make a diagnosis. Given the relatively high mortality of patients with angina who are not appropriately treated, you should consult a cardiologist, especially if you have some risk factors, such as diabetes, hypertension, dislipidemia, smoking, and a family history of heart disease.

If symptoms last 15 minutes or longer, special attention should be paid because it may suggest more unstable conditions, such as myocardial infarction. You have to visit the emergency department as soon as possible.

Let's gather cats

Are you a dog person or a cat person?

 

There are distinctive differences in characteristics between dogs and cats, although both are very popular as a pet here in Japan. In general, cats are thought to be more standoffish whereas dogs are likely to be more loyal.

I thought I was more of a dog person, but my mind has changed since I came across an app called Neko Atsume, which was developed in Japan and means "Let's gather cats" in English.

 

The rule of the game is very simple. You put food in your garden and then see cats gathering to eat the food. One interesting aspect is that the characteristics of cats are different each other. As you can see below, a white fat cat is sleeping peacefully after eating a big meal, a brown one is playing with the body hiding in a bucket, one having a bat seems to be a baseball fan.

 

 

Actually you cannot touch or catch them. Cats come on a whim when there is food and leave without saying anything when getting tired. Taking a picture of them and keeping the photos in your cat album is only allowed in this game. Nevertheless, this app has been fascinating to me for months. Also you may be, more or less, addicted to their cuteness.

From now on, I won't say I am a dog person.

Also you wouldn't even though you prefer dogs to cats.

No underpants

Last night, after taking a bath, I found no underpants in the dressing room. I usually put a pair of pajamas and underwears on the shelf before bathing, but I was likely to forget to bring my underpants. All of my clothes are upstairs, so I decided not to wear it.

Some women appear to have a habit of wearing no bra and panties on the bed, but it is not common among men. I am an averaged person and I have never slept without underpants before last night. I was worried I would catch a cold but nothing bothered me at all.

Sleeping with no underwear may have a few advantages.

• Can save money to buy underpants.
• Can save time to go to clothes shops.
• Can save water to do the laundry.

I am not going to encourage you to give it a try because possible contribution, if any, is a bit. However, no-pnats-sleep may be invaluable in a certain situation. For example, it would work well in August in Japan because it is boiling hot and disgustingly humid.

At last I have to say that wearing no underpants was very handy when I went to the rest room. Concerns about poor sanitation were raised, though.

Heart in the heart

Here is a simple question.
Can you see anything unusual and funny on the chest radiograph?

There is an inverted love mark in the cardiac silhouette.
So, you would say, "Heart in the heart!"

A diagnosis of esophageal hiatal hernia was confirmed by computed tomography and gastroscopy. The upside down heart in the present case was likely to be created by the trapping air in the stomach protruding into the chest cavity through the opening of the diaphragm.

The patient has been doing well for almost three years with antacids.

Star Wars

I guess that everyone has heard of "Star Wars", a sci-fi movie. I am a big fan of sci-fi movies and happy to know that a new series of Star Wars, Episode VII The Force Awakens, is coming this December.

My daughter and I enjoyed watching Star Wars Episode I, II, and III last weekend. Unexpectedly, the Episode III that I got was not dubbed into Japanese; only English and Chinese subtitles were available. I wanted to use English subtitles so that I could understand the story more, but my 12-year-old daughter declined it because it might disturb the beautiful computer generated images (CGI). Another likely reason is that she was unable to read English. I had no choice but to watch the movie only with English voices.

This is my first time to watch English movies without subtitles, but I was able to follow the story more than I would expected. It is unclear how well my daughter caught the story, but I am 100% sure that she had a lot of fun with the movie because the CGI effects were exceptional.

While watching these three series of Star Wars, I have realized that the CGIs looked more fantastic in Episode III than in Episode I or II. This is because no subtitle in Episode III enabled me to focus more on the CGIs, I think.

I have to say, "Thank you, my daughter." Her request (i.e., no subtitle) reminded me of a real attractiveness of sci-fi movies.

A raw egg

I thought that what non-Japanese people really hate to eat was Natto or fermented soy beans. However, I have recently recognized my misunderstanding. It is likely to be impossible for them to try a raw egg although we Japanese often enjoy having dishes with a raw egg, such as Sukiyaki, Beef bowl, and Udon noodle. Among them, Tamago Gake Gohan, as shown below, is my best because of the balance between the taste and simpleness.

I often eat Tamago Gake Gohan for breakfast and cannot get enough of it. Let me explain how to cook this wonderful dish. All you have to do is to put a raw egg and pour soy source over hot rice. That's it. Stirring them before eating would make the taste more yummy.

The other day, a famous American educator, who has live in Japan for more than 30 years, said on the radio that she really hated rice with a raw egg but not natto. That made me really disappointed.

Let me give you some tips if you give it a try. First, use a fresh egg, or you will suffer from abdominal pains, diarrhea, and vomiting. Micro organisms could grow, such as Salmonella, especially in summer or a rainy season. Second, do not take a while to cook, or the egg will go bad. You should know that micro organisms love room temperature.

Finally, more importnat, do not try to eat if you feel disgusting when you take a look at the picture above. It is quite rare to look unappetizing but taste good. People get more information from their eyes than from the taste buds while eating.

Maybe everything is under the control of the brain.

Ventricular fibrillation

Here is quite a rare electrocardiogram (ECG). The point is that it is not a monitor recording but a standard 12-lead ECG.

This is one of the most scary arrhythmias, called ventricular fibrillation. Death would be unavoidable, unless the arrhythmia ceased spontaneously in a few minutes. To save a patient with ventricular fibrillation, cardiac resuscitation, followed by electrical defibrillation, is required as soon as possible.

Given that it takes dozens of seconds to record a standard 12-lead ECG, the present ECG is no doubt extremely uncommon. I would say that you have never seen an ECG like this, even though you are an experienced cardiologist. Actually, this is my first time during about 20 years of clinical experience as a cardiologist.

I quote this ECG from my website, where more than 300 ECGs with a simple explanation are available free of charge. While I was uploading an ECG of ventricular fibrillation, my little child, kindergartener at that time, mumbled anxiously, "Oh my goodness...he's dead." Of course, he has never learned about ECG.

Ventricular fibrillation seems to be so striking that even kids cannot help feeling something ominous.

Creeper

Minecraft is a popular online game released in 2009. I do not know much about Minecraft, but my two sons are really into it. In Minecraft, you are likely to be in a world of blocks. Everything is made of various kinds of blocks, such as metal, wood, soil, or ice. You can create whatever you want to make with these blocks. So many fantastic works on YouTube may frighten you because they are beyond the limitation of your imagination.

Creeper is an enemy that you fight against in Minecraft. Literally, Creeper seems to be made up of plants, watches and follows you eerily, and, once in a while, explodes. You may be injured or killed.

Last weekend, my younger son, who is in second grade at elementary school and a big fan of Minecraft, asked me to create Creeper. Surprisingly, he was already planing to use cardboard boxes as the frame work and folding papers for the pixelated appearance.

The process was way much tougher than I expected, but my son did make it with my support. Actually, it took two or three hours but he continued to work with fun. I respect his approach and endurance.

A fun-loving attitude and never-give-up spirit are what I really want my kids to have.

The heart

Have you ever seen your heart? I guess that you would say "Of course not." Believe it or not, I have!

To be honest, it is almost impossible to directly see your own heart with your naked eye. Such situations, if ever, would lead to your death in a minute. An indirect way to see your heart, however, is available. Medical institutions have a variety of devises that make it possible to depict the heart, for example echocardiography, computed tomography, and magnetic resonance imaging.

Among these medical modalities, echocardiography is the most recommended. All you have to do is that you put an ultrasonographic probe on the chest after lifting up your shirt. It is very convenient and handy, isn't it?. Another advantage of echocardiography is no need for radiation exposure. In my hospital, I usually show my patients a movie of their heart, as shown below.

 

My small gift always surprises my patients. It seems like that they are impressed and satisfied to see his or her heart beating dynamically and continuously. They say, "Oh, this is my heart? Awesome! Thank you, doctor. You are so nice." Also, their words make me feel good and motivate me to work more heartily.

P.S.
Some may care about the cost to examine the heart by echocardiography. Luckily, it is affordable in Japan: almost 10 to 30 dollars on health insurance. I have heard that it would cost too much in the U.S., at least 10 times higher than in Japan, to undergo echocardiography, although it seems to vary depending on a hospital where you are examined.