News & Articles

What is Cardiovascular Disease?

Alpine Cardiology Blood Pressure


Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. CVD can refer to a number of conditions. Some of these might develop at the same time or lead to other conditions or diseases within the group. Common complications include heart attack, chest pain (angina), or stroke.


Cardiovascular Disease

Alpine Cardiology - Heart AttackDiseases and conditions that affect the heart include:

  • Angina – chest pain that occurs due to decreased blood flow into the heart
  • Arrhythmia – an irregular heartbeat or heart rhythm
  • Congenital Heart Disease – a problem with heart function or structure is present from birth
  • Coronary Artery Disease – affects the arteries that feed the heart muscle
  • Heart Attack – a sudden blockage to the heart’s blood flow and oxygen supply
  • Heart Failure – the heart cannot contract or relax normally
  • Dilated Cardiomyopathy – heart failure in which the heart gets larger and cannot pump blood efficiently
  • Hypertrophic Cardiomyopathy – the heart muscle walls thicken and problems with relaxation of the muscle, blood flow, and electrical instability develop
  • Mitral Regurgitation – blood leaks back through the mitral valve of the heart during contractions
  • Mitral Valve Prolapse – part of the mitral valve bulges into the left atrium of the heart while it contracts, causing mitral regurgitation
  • Pulmonary Stenosis – a narrowing of the pulmonary artery reduces blood flow from the right ventricle (pumping chamber to the lungs) to the pulmonary artery (blood vessel that carries deoxygenated blood to the lungs)
  • Aortic Stenosis – a narrowing of the heart valve that can cause blockage to blood flow leaving the heart
  • Atrial Fibrillation – an irregular rhythm that can increase the risk of stroke
  • Rheumatic Heart Disease – complication of strep throat that causes inflammation in the heart and which can affect the function of heart valves
  • Radiation Heart Disease – radiation to the chest can lead to damage to the heart valves and blood vessels

Alpine Cardiology Explaining StrokeVascular diseases that affect the arteries, veins, or capillaries throughout the body and around the heart include:

  • Peripheral Artery Disease – causes arteries to become narrow and reduces blood flow to the limbs
  • Aneurysm – a bulge or enlargement in an artery that can rupture and bleed
  • Atherosclerosis – plaque forms along the walls of blood vessels, narrowing them and restricting the flow of oxygen rich blood
  • Renal Artery Disease – affects the flow of blood to and from the kidneys and can lead to high blood pressure
  • Raynaud’s Disease – causes arteries to spasm and temporarily restrict blood flow
  • Peripheral Venous Disease – general damage in the veins that transport blood from the feet and arms back to the heart. This may causes leg swelling and varicose veins
  • Ischemic Stroke – a blood clot moves to the brain and causes damage
  • Venous Blood Clots – can break loose and become dangerous if they travel to the pulmonary artery
  • Blood Clotting Disorders – blood clots form too quickly or not quickly enough and lead to excessive bleeding or clotting
  • Buerger’s Disease – leads to blood clots and inflammation, often in the legs, and which may result in gangrene

Risk factors for Cardiovascular Disease

Behavioral Risks

  • Unhealthy Diet – Reduce fat and salt, eat more fruit and vegetables.
  • Physical Activity – Increase physical activity, even walking just 10 minutes a day can make a difference. Ideally physical activity 30-60 at least 3 times a week.
  • Tobacco Use – Quite smoking, vaping and other tobacco products.
  • Obesity – Increases risk of CVD and diabetes
  • Alcohol – Excessive alcohol consumption can increase your cholesterol and blood pressure levels.

Heredity Factors

  • Familial Hypertrophic Cardiomyopathy – A common inherited heart condition that can affect people of any age.
  • Family history of heart attack, stroke or high blood pressure – Talk to your health care team
  • Familial Dilated Cardiomyopathy – One or more relative who has been diagnosed with dilated cardiomyopathy. Without a known cause you are at higher risk and should talk to your physician.
  • Family history Hypercholesterolemia – If you have a familial hypercholesterolemia, your LDL is usually very high. If high cholesterol is caused by genetics symptoms can begin at a very young age.

Other Risk Factors

Age – CVD is most common in people over 50

Gender – Men are more likely to develop CVD at an earlier age than women


Common symptoms

  • Pain or discomfort in the center of the chest
  • Pain or discomfort in the arms, left shoulder, elbows, jaw, or back
  • Numbness of the face, arm, or leg. specifically on one side of the body
  • Confusion or difficulty speaking or understanding speech
  • Difficulty seeing with one or both eyes
  • Difficulty walking, dizziness and/or loss of balance or coordination.
  • Severe headache with no known cause
  • Fainting or unconsciousness



Often, there are no symptoms of the underlying disease of blood vessels. A heart attack or stroke may be the first sign of underlying disease.

If you are experiencing any of these symptoms call 911 immediately and seek medical care.

Cardiovascular Disease is easier to treat when detected early. Talk to your doctor about your concerns regarding your heart health. Your doctor can work with on steps you can take to reduce your heart disease risk. This is especially important if you have a family history of heart disease.



Dr Bobish and her team are here to help you navigate your risk factors and guide you on preventative steps you can take.

Heart Healthy Holiday Tips

Alpine Cardiology - Heart Healthy Turkey


It is that that time of year again, celebrations with family and lots of food. Keeping your diet heart healthy during the holidays can be challenging. Many of the dishes that we look forward to all year are loaded with salt, fat, sugar and other unhealthy items. You can have a heart healthy holiday meal without sacrificing flavor by making some simple substitutions.

Refer to our heart healthy substitution tips when planning your holidays meals. You can either save it to your computer or print it out to keep handy. Click here to download..

Tips for heart healthy holiday meals

Start with a delicious healthy soup. This pumpkin soup with hints of spices makes it a sweet/savory dish that is perfect for the start of your meal.

Alpine Cardiology - Heart Healthy Pumpkin Soup


  • 1-1/2 cup water, divided
  • 1 small onion, chopped
  • 2 cans (15 ounces each) pumpkin
  • 4 cups unsalted vegetable broth
  • 1 teaspoon ground cinnamon
  • 1/2 teaspoon ground nutmeg
  • 2 cups fat-free milk
  • 1/4 teaspoon black pepper
  • 2 green onion tops, chopped


  • Heat 1/4 cup of the water over medium heat. Add the onion and cook until tender (about 3 minutes). Don’t let the onion dry out.
  • Add remaining water, pumpkin, broth, cinnamon, and nutmeg.
  • Bring to a boil, reduce heat and simmer for 5 minutes.
  • Stir in the milk and cook until hot. DO NOT BOIL
  • Ladle soup into bowls and garnish with black pepper and green onion tops. Serve immediately. Serves 8.

For more heart healthy recipes to enjoy during the holiday season or anytime visit our recipe category in our articles on our website or click here.

Use our heart healthy substitution tips to make all your family favorites healthy and delicious. Your heart will thank you.

Winter and your Heart


Winter is near for Northern Michigan and that means the temperatures will drop and the snow will fall. A study in the journal JAMA Cardiology found that heart attack rates increase most when the temperature dips below freezing.

Alpine Cardiology shoveling snowIf you have a heart condition or are older, you may be vulnerable in winter months. It is harder for older people to regulate their own body temperature. This puts them at higher risk in extreme weather.

How does Cold Weather Affect the Heart?

Freezing weather can put stress on the body and affect your heart in number of ways. The cold can cause our bodies to make certain adjustments in order to maintain our core body temperatures. These normal adjustments could be a challenge for people with heart disease. Cold temperatures can cause:

  • Alpine Cardiology - checking temperatureYour blood pressure to increase.
  • Heart rate increases
  • Your heart to work harder.
  • Blood thickens in chilly weather and may lead to blood clots.

The winter months are when people have more colds and flu. A recent study showed that the risk of a heart attack was significantly higher in the first 7 days after an infection. Colds, flu, or pneumonia cause infections in the lungs and will make your heart work harder.

Alpine Cardiology - exercising

Do not Hibernate!

Regular exercise is still important for your heart health even when the seasons change. Instead of walking outside when it is below freezing, walk at a mall or big box store. Take a class in yoga or other exercise or swim at an indoor pool. Regardless of the temperature outside, you still need to add movement to your daily life. Take the stairs, walk the hallways during breaks or exercise at home with a DVD or YouTube video.


Cold Weather Precautions

Alpine CardiologyBesides the obvious of wearing warm clothing when heading out in the cold there are other precautions you can take to protect you and your heart in cold weather. Cover your mouth and nose with a scarf to help warm the temperature of the air you breathe. If you must dig out of the snow, ask for help. If help is not available, shove small loads instead of lifting heavy loads. Take frequent breaks inside and warm up and drink plenty of water.

You also want to be careful not to become overheated. Dressing warmly then engaging in physical activity can lead to overheating. If you are out in the cold and find yourself sweating, you are over heated. If you have heart disease, consider this to be a danger sign. Stop what you are doing and go inside and take a break.

Other Precautions to Take

Alpine Cardiology - Flu VaccineYou can also help prevent heart problems that come in the winter months by building up your body’s defense against colds, flu, and other infections.

  • Get a flu shot every year
  • As your healthcare provider if you should get a vaccine for pneumonia
  • Wash your hand often with soap and water.
  • Get at 7-8 hours of sleep a night
  • Do not smoke
  • Exercise regularly

Know the signs of a heart attack

Alpine Cardiology - EMS

Call 911 if you have any of these most common symptoms

  • Chest pain
  • Pain in one or both arms
  • Pain in the back, shoulders, neck, jaw, or upper part of the stomach (may be mistaken for indigestion)
  • Shortness of breath
  • Sweating
  • Nausea and vomiting

Talk to your Healthcare Team

If you are not sure how healthy your heart is, talk to your doctor. They can understand your risk and advise you on the proper precautions for you.

Knowing your risk factors and taking the right precautions will help you stay healthy and heart strong.

An Apple a Day Keeps the Doctor Away

Alpine Cardiology Apple Orchard


It is Fall in Northern Michigan which means it is apple harvest time! You know what they say about apples and doctors.  This adage has been put to the test many times over the years. An apple a day doesn’t mean you get to skip out on regular preventative appointments, but research has shown that daily apple eaters appear to use fewer prescription medications.

Alpine Cardiology ApplesA 2020 article in Critical Reviews in Food Science and Nutrition that included 16 studies, found many heart-related benefits for those who include apples in their diet. Eating one medium apple a day may help lower blood pressure, cholesterol, and inflammation according to the article. Unpeeled apples are a good source of fiber and compounds called polyphenols that benefit heart health.

Apples are abundant in Northern Michigan this time of year and there is nothing better than taking a big bite out of a crisp apple fresh from the orchard. You don’t have to eat apples plain to get health benefits, below are some heart healthy easy and delicious recipes to help add apples to your diet.

Alpine Cardiology Yogurt fruit dip

Honey-Vanilla Yogurt Dip

This easy dip isn’t just for apples. It is delicious with bananas, strawberries, peaches, and most other fruits. Try making a fruit parfait by creating layers of the dip, fruit and low-fat granola as a quick breakfast or snack any time of the day.


Mix 1-1/2 cup fat-free, plain Greek yogurt with 1 tablespoon of honey and 1 teaspoon vanilla extract. It is that simple!

For added flavor you can add a tablespoon of apple pie spice. Want to make your own apple pie spice? Mix 1/2 tablespoon cinnamon, 1/4 tablespoon nutmeg, 1/8 tablespoon allspice and 1/8 tablespoon cardamom.

Apple Nachos


This is a quick and tasty treat, a perfect midday snack that is easy to make. You can substitute any dried fruit or nuts and seeds that you would like. Make sure that the dried fruit is unsweetened, and the nuts and seeds are unsalted.


  • Alpine Cardiology Apple Slices3 medium apples, cored and thinly sliced
  • 1-2 teaspoons fresh lemon juice
  • 1/4-1/3 cup dried unsweetened cranberries or raisins
  • 1/4 -1/3 cup sliced or chopped unsalted almonds or walnuts
  • 2-3 tablespoons unsalted shelled sunflower or pumpkin seeds.
  • 2 tablespoons water
  • 1/4 cup smooth low-sodium peanut butter
  • 1 tablespoon honey


  • Mix the dried fruit, nuts, and seeds in a small bowl.
  • Layer half the apples on a large plate or platter. Sprinkle with lemon juice to keep from browning.
  • Microwave 2 tablespoons of water in a small bowl on high power until boiling. Add in peanut butter and honey, stirring until smooth.
  • Drizzle half the peanut butter mixture over the apple slices. Sprinkle half the dried fruit mixture and then layer the remaining apples.
  • Drizzle second apple layer with the peanut butter mixture and sprinkle the remaining dried fruit mixture over all of it.
  • For variety, you can add low-fat granola or unsweetened shredded coconut


Oven Baked Fall Goodness

With fall comes cool nights and there is nothing better than the smell of apple desserts in the oven. Below are 2 ways to prepare apples for a delicious heart healthy warm fall goodie.

Quick Apple Crisp (serves 6)

An easy and quick recipe for a heart healthy apple crisp. Serve as is or dust with powdered sugar or drizzle with one of the icing ideas at the end of this article.


  • Alpine Cardiology Apple Crisp1/3 cup graham cracker crumbs
  • 1/3 cup quick oats
  • 2 tablespoons brown sugar
  • 1 teaspoon cinnamon
  • 2 pounds apples (about 6, medium sized)
  • 1/2 cup water
  • 1 tablespoon butter


  • In a small bowl, mix graham cracker crumbs, oats, and brown sugar.
  • Wash and peel apples. Quarter them, cut out core and seeds. Slice apple quarters.
  • Spread apples in a 12×8 inch baking pan.
  • Add 1/2 cup water to the pan.
  • Sprinkle cinnamon and topping mixture over apples.
  • Dot with butter.
  • Bake at 375 degrees for 45 minutes or until apples are soft and topping is browned.

Courtesy of John Hopkins Medicine

Apple Coffee Cake (serves 20)

For less servings, use an 8×8 pan and reduce the ingredient measurements by half. This too can be served plain or dusted with powdered sugar. For a little more sweetness, lightly drizzle one of the icing ideas at the end of the is article.


  • Alpine Cardiology - heart healthy Apple Cake5 cups apples, cored, peeled, and chopped
  • 1 cup sugar
  • 1 cup raisins
  • 1/2 cup pecans or preferred nut
  • 1/4 cup vegetable oil
  • 2 teaspoons vanilla
  • 1 egg, beaten
  • 2-1/2 cups sifted all-purpose flour
  • 1-1/2 teaspoon baking soda
  • 2 teaspoons ground cinnamon


  • Preheat oven to 350 degrees
  • Lightly oil a 13x9x2 inch pan
  • In a large mixing bowl, combine apples with sugar, raisins, and pecans (nuts) and mix well. Let stand for 30 minutes.
  • Stir in oil, vanilla, and egg.
  • Sift together flour, baking soda, and cinnamon. Stir into apple mixture about one third at a time. Stirring just enough to moisten dry ingredients.
  • Pour batter into pan. Bake 35-40 minutes until a toothpick inserted in the center of the cake comes out clean.
  • Cool cake slightly before serving.

Courtesy of National Heart, Lung, and Blood Institute

Powdered Sugar Icing

Alpine Cardiology Apple Coffee cake with icingFor a little added sweetness drizzle icing made with 1 cup powdered sugar, 1/2 teaspoon vanilla and 1-2 tablespoons of low-fat milk. You may substitute coconut, soy, rice, or almond milk.

Icing variations:

Apple Spice Icing: Add 1 teaspoon apple pie spice

Apple Cider Icing: Substitute apple cider for milk and omit the vanilla extract. Add dash of cinnamon if desired.

Chocolate Icing: Add 2-3 tablespoons cocoa powder. May require a little extra milk.

Citrus Icing: Substitute lemon, lime or orange juice for the milk and omit the vanilla extract. Add a little zest if desired.

Almond Icing: Substitute 1/2 teaspoon almond extract for the vanilla extract.

Maple Icing: Substitute 1/2 teaspoon maple extract for the vanilla extract.

Healthier Caramel Sauce

Alpine Cardiology Caramel SauceNotice we didn’t say heart healthy, we said healthier. That is because caramel is not considered a heart healthy treat normally. Most caramel sauces use heavy cream and a lot of butter and refined sugar. This recipe is considered healthier because it uses less butter and low-fat milk. It still uses refined sugar, because after all it is caramel. This doesn’t mean you can never have it; just means you indulge once in a while as a treat. You can dip apples in the sauce or drizzle over any of the recipes above.


  • 1 cup sugar
  • 1/4 cup 2% milk
  • 2 tablespoons unsalted butter


  • In a medium saucepan, heat sugar over low-medium heat. Stir constantly until sugar is melted and medium brown color. Remove pan from heat.
  • Add milk and butter to the melted sugar and stir immediately.
  • There will be a lot of bubbling! Once bubbles settle down, return pan to stove over low heat.
  • Stir until caramel is a smooth syrup.
  • Pour sauce in a heat-safe bowl to cool slightly.

Fall Fruit and Produce In Season

Take advantage of fall fruits and produce and make them a part of your heart healthy lifestyle. If you have questions about adopting a heart healthy lifestyle, reach out to your health care team. They can advise you about exercise, diet, risks etc. 

Dr. Bobish and her team will listen to you. They focus on preventative care and providing their patients with the tools needed to live a heart healthy lifestyle. Call our office at 989-448-7002 and talk with one of our staff members, you do not need to be referred by a doctor to schedule an appointment.

Your Heart and Exercise

Alpine Cardiology seniors exercising in swimming pool




Your doctor will tell you what exercise is best for you that will help your heart and are safe for you. They will also advise you on things to watch for and what you should do if you experience heart symptoms.

Your Heart and Exercise

Alpine Cardiology senior athletes exercising on step platforms at gymGetting regular exercise is a major step toward good heart health. Physical activity can strengthen the heart muscle, manage blood pressure, high blood sugar and cholesterol levels. It is also an effective way of keeping your weight under control.

Exercise is important whether you have heart disease or want to prevent it. The activity doesn’t have to be hard. Any activity that raises your heart rate can help your heart. Do an activity at a level that is right for you and that you enjoy.

Moderate Level

If you choose moderate activity, aim for 30 minutes a day, 5 days a week. Experts recommend at least 150 minutes of moderate exercise per week. Moderate activity would include brisk walking, brisk cycling, or dancing. Even daily chores that raise your heart can be included. You want your heart beating faster.

Vigorous Level

Alpine Cardiology senior cyclistIf you choose vigorous activity, aim for 25 minutes a day, 3 days a week. Experts recommend at least 75 minutes of vigorous exercise per week. Vigorous activity would include jogging, fast cycling, or cross-country skiing. You breathe more rapidly and heart beats much faster with vigorous activity.

Any Movement is Good for your Heart

Any activity is better than none. If you can’t fit in one 30-minute walk, try a few 5 or 10-minute walks instead. Brief bouts of activity do offer benefit. Being active for short periods of time during the day add and can provide health benefits.

Sitting too much can have a negative impact on your health. The more hours you sit each day, the higher your risk of metabolic problems. Remember that your goal is to make regular physical activity a part of your heart healthy lifestyle.


The Best Exercises to Strengthen your Heart

Talk with your health care team about which exercises are best for you. Along with advice from your doctor you may consider working with a physical therapist or trainer. They can show you proper exercise strategies to reduce fatigue and the possibility of injury from over doing it. You may also want to talk to your doctor to see if you may be eligible for a formal cardiac rehabilitation program.

Different types of exercise are needed to provide complete fitness. Aerobic exercise and resistance training are the most important for heart health. Flexibility may not contribute directly to heart health; it serves an important role in providing a good foundation for participating in aerobic and strength building activities more effectively.

Aerobic Exercise

Alpine Cardiology Senior couple cross-country skiing.Aerobic exercise improves circulation, and this helps in lower your blood pressure and heart rate. Increasing your overall aerobic fitness will help with how well your heart pumps and delivers oxygen to your body. Aerobic exercise also reduces the risk of type 2 diabetes, if you already live with diabetes, it can help you control your blood glucose.

Aerobic Exercise includes walking, running, swimming, cycling, playing tennis, jumping rope, mowing the lawn. You can choose the level previously mentioned that is right for you. Regardless of whether you choose a slower or faster pace, the goal is to get your heart pumping.

Resistance/Strength Training

Alpine Cardiology Senior people with trainer using resistance band doing exercises at the gymResistance or strength training may improve your strength and help your muscles work together better. This can make daily activities easer and build muscle and burn fat. It may also help with flexibility and stability (balance).

Research show that a combination of aerobic exercise and resistance work may help raise HDL (good) cholesterol and lower LDL (bad) cholesterol.

You should try for at least 2 nonconsecutive days per week of resistance/strength training. You may choose to work with free weights (such as hand weights, dumbbells, or barbells), or on weight machines. Resistance band are effective way to build strength with many exercises able to perform in a sitting position. Body resistance exercises such as push-ups, squats and chin-ups can be added as well.

Stretching, Flexibility and Balance

Alpine Cardiology senior woman stretching at homeStretching before exercise is important to warm up your muscles and heart. This benefits musculoskeletal health which helps you stay flexible and free from joint pain. Stretching may also help with cramping and other muscular issues. Flexibility is a critical part of being able to maintain aerobic exercise and resistance training.

Flexibility and balance exercises help maintain stability and prevent falls as well.

Talk to your doctor to see if she recommends basic stretches you can do at home. You can also look for DVDs or YouTube videos to follow. Tai Chi and Yoga are great for your heart health and will help you strengthen you muscles and increase flexibility.

Other Benefits of Regular Exercise

Being active does more than just keep your heart healthy. It keeps your body and mind health too.

Alpine Cardiology Senior woman exercising with a hula hoopThe added benefits of regular exercise include:

  • Mental well-being
  •  Stress relief
  • Increased bone strengths (if you are doing weight bearing exercises)
  • Control blood sugar
  • Lose or control you weight
  • Increase energy
  • Help you sleep better

Alpine Cardiology Senior drinking water after exercisingAdditional Recommendations

  • Talk to your doctor before starting any new exercise or physical activity.
  • Start slowly and at a level you are comfortable with.
  • If you feel tired or have any heart symptoms, stop, and rest.
  • Wear comfortable clothing for the activity you are doing.
  • During warmer weather exercise in the morning or evening when exercising outside.
  • In colder weather cover your nose and mouth when exercising outside
  • If you prefer inside, go to a gym, and use the treadmills or walk inside a mall.
  • Drink plenty of water.

It is Never too Late to Start

Alpine Cardiology smiling senior sportsman exercising with dumbbell at gymIt is never too late to make physical activity part of your life. If you are healthy, it can help you keep your heart as healthy as possible. If you have had a heart attack or stroke, being active is very important to help prevent another one.

Regular activity might also help your heart if you do have a heart attack. It may increase the number of smaller blood vessels that connect different coronary arteries. These are called collateral blood vessels. If one of the major coronary arteries is suddenly blocked, these collateral blood vessels serve as an alternate route to supply blood to the portion of the heart muscle that is threatened by a heart attack. This gives you time to seek medical attention and increases your chance of surviving.

Talk to your Doctor

Tell your doctor if you are having trouble making activity part of your daily life. She may refer you to someone who specializes in helping people make lifestyle changes. If you have been exercising and find that you are not able to as much as you used to let your health care team know.

Studies indicate that pairing a healthy diet with regular exercise is the best way not only to prevent heart disease, but to reverse some risk factors. Talk to your doctor to about activities and diet that will increase your heart health.

Warning Signs of a Heart Attack


If you think you are experiencing symptoms of a heart attack – DO NOT WAIT, CALL 911!

Symptoms may be obvious or more subtle, either way take them seriously and get medical care.

We tend to believe that a heart attack is a dramatic, chest-clutching event but heart attacks can begin with more subtle symptoms. People have described it as a “discomfort” but not painful.

Downplaying your symptoms or thinking it is just indigestion or anxiety can be deadly. Do not “tough it out” for more than five minutes. Call 911 immediately.

What is a Heart Attack?

A blockage most often is a build up of fat, cholesterol and other substances which form a plaque in the arteries that feed the heart. The buildup can block the flow of blood to the heart and a heart attack can occur.

Sometimes, a plaque can rupture and form a clot that blocks blood flow. The interrupted flow can damage or destroy part of the heart muscle.

Typical Heart Attack Symptoms

Alpine Cardiology Senior man having heart attack wife calling 911If you experience any of these heart attack warning signs do not wait to get help. Some heart attacks may be sudden and intense. But most will start slowly, with mild pain or discomfort. Call 911 if you experience any of these symptoms:

Chest Discomfort or pain

A tight ache, pressure, fullness or squeezing in your chest. This may come and go.

Upper body pain

A pain or discomfort that may spread beyond your chest. Areas include shoulders, arms, back, neck, teeth, or jaw. You may have these symptoms WITHOUT any chest discomfort.

Stomach pain

Often mistaken for heartburn, the pain may extend down towards your abdominal area.

Shortness of breath

You may try to take in deep breaths or pant. This often occurs without any chest discomfort or before chest discomfort occurs.

Alpine Cardiology - Couple walking in park


Sometimes you may think you are having a panic attack or feel a sense of doom for no apparent reason.


You may feel dizzy or feel like you may pass out.


Suddenly breaking out in a sweat with cold clammy skin.

Nausea and vomiting

Feeling sick to your stomach or vomiting may occur.

Heart Palpitations

You may become very aware that your heart is beat or feel as if your heart is skipping beats.

Women may have different symptoms

Alpine Cardiology - Cardiologist listening to woman's heartThe most common heart attack symptom for women is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms. Particularly shortness of breath, nausea/vomiting, back pain, or jaw pain. May women have heart attack symptoms without chest pain.

  • Pain in the neck, back, shoulders or jaw
  • Shortness of breath
  • Abdominal pain or “heartburn”
  • Pain in one or both arms
  • Nausea or vomiting
  • Dizziness or fainting
  • Unusual or unexplained fatigue, possibly for days

Older Adults and People with diabetes

Older adults and people with diabetes may have no or very mild symptoms of a heart attack. Never dismiss any heart attack symptom, even if they don’t seem serious. Seek immediate medical care.

Symptoms May Vary

Heart attacks do not present with the same symptoms or severity of symptoms. Some have mild pain while others have more severe pain. Some have no symptoms at all, the first sign may be sudden cardiac arrest. The signs and symptoms you have, the greater the chance you are having a heart attack.

Many people may have warning signs and symptoms hours, days, or weeks in advance. A heart attack can also strike suddenly. The earliest warning may be a recurrent chest pain or pressure that occurs with activity and is relieved by rest. This may be caused by a temporary decrease in blood flow to the heart.

When to Seek Medical Care

Alpine Cardiology Calling 911 and checking for pulseImmediately! Do not wait too long because you don’t recognize the important signs and symptoms.

Call 911

If you think you are having a heart attack, don’t wait. Immediately dial 911 (or your local emergency number). If you don’t have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options.

Take nitroglycerin

ONLY if it is prescribed to you by your doctor. Take it as instructed while awaiting emergency help.

Take an aspirin

ONLY if recommended by your doctor or emergency medical personnel. Taking an aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, so important to only take if instructed to do so. Do NOT delay calling 911 to take an aspirin, call for help first.

What to do for Someone having a Heart Attack

First, call 911 or emergency medical help. After calling for help, check to see if they are breathing or have a pulse. If a person isn’t breathing or doesn’t have a pulse, then you should begin CPR

It is recommended performing only chest compressions if you haven’t been trained in CPR. If you have been trained in CPR you can go on to opening the airway and rescue breathing.

Minutes Matter – Fast Action Can Save Lives

Alpine Cardiology EMS caring for heart attack patientCalling 911 is almost always the fastest way to get lifesaving treatment.

An emergency medical services team will begin treatment when they arrive. This means that treatment could begin up to an hour sooner than arriving by car to the hospital. Plus, patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital.

Talk to your Health Care Team

If you would like more information on the warning signs of a heart attack and your risks talk to your health care provider. Dr. Bobish and her team want you to be heart healthy, talk to them. They know your health history and are one of your best resources to understand your risks and way to prevent a heart attack.

Salt is NOT the only seasoning!

We all remember being in the kitchen as a child and Mom or Grandma tasting something on the stove. It seems they always said, needs more salt. Why is salt our go to seasoning to add to food?

Salt is used as a flavor improver and can affect other flavors such as sweet and bitter. When small amounts are used it will reduce bitterness and increase sweet. There is a role for small amounts of salt in a heart healthy diet, you just have to make sure your daily intake from all sources (processed foods, ready-made products, etc.) are within your doctor’s recommended range.

There are many great alternatives to adding salt while cooking or at the table. Salt is not the only thing that improves flavor. Herbs and spices can liven up your food and add variety, plus they are better for your heart health than salt.

Below we will offer some common herbs and spices that are easily found fresh in most grocery store produce section and in the spice aisle.


A popular herb with a hint of sweetness and a little spiciness. A member of the mint family, basil has incredible flavor with a floral aroma. Fresh basil leaves are delicate, and it is best to tear it or use a sharp knife.

Basil can be used during the cooking process or added to a dish right before serving. Basil pairs well with tomatoes and tomato based dishes. It will also add great flavor to vegetables, fruit, eggs, chicken, and fish dishes. You can use basil along with garlic, balsamic vinegar, mint, lemon, and oregano for different flavor combinations.

One of the most well-known dishes with basil is the Caprese Salad. Layer basil leaves over tomato slices and mozzarella cheese and lightly drizzle with olive oil for a delightful summer salad.


Mint is a bright and refreshing herb that works in sweet and savory dishes. It is similar to basil and can be prepared the same way.

Mint is great in salads, pasta, couscous and tasty with carrots, peas, and broad beans.
For simple refreshing snack chop up melon and drizzle the fruit with a mixture of mint and low-fat vanilla yogurt.


Oregano is a popular herb in Greek, Italian, Mediterranean, and Latin American cooking. It has an earthy, aromatic and slightly bitter taste.

Oregano can be used in marinades for meats, poultry, and seafood. Use in egg dishes, breads casseroles and sauces. It pairs well with basil, lemon, or mint in marinades, on vegetables or sauces.

Try sprinkling a little oregano on hamburger, chicken or baked potato add to soups and sauces for extra flavor.


Rosemary is an aromatic herb with a woodsy and lemony flavor. Use sparingly, it can overpower other flavors.

Rosemary pairs well with soups, stews, and other comfort foods. Whole sprigs baked with poultry or fish adds wonderful flavor. Rosemary if very versatile and can be used with other herbs and spices and in most dishes. Meats, vegetables, sauces and grains all pair well with Rosemary.

Rosemary, garlic, and pepper added to brown rice while cooking adds wonderful flavors, one of our favorite uses for rosemary.


Thyme has a very pronounced and robust taste. It could be described as sweet; however, it shouldn’t be used in desserts.

Thyme is a versatile seasoning to use in cooking. It is a sodium free way to boost flavor in roasted vegetables, meats, soups, stews, and sauces.

Try adding whole sprigs to slow cooked meals and casseroles and remove at the end. Tuck sprigs inside a chicken along with fresh lemon before roasting. Thyme is one of those herbs that can up to long cooking times.


Dill has a strong taste and is often compared to fennel, star anise and celery. Best used fresh if possible and use only the leaves and discard the stems.

While many people associate dill with pickled cucumbers, it is a very versatile herb. It pairs well with chicken and fish dishes, potato salads, noodle, or tomato-based salads.

Add a dill sprig to roasting chicken or fish with a little lemon or lime juice.


Sage is like Rosemary with more lemon and eucalyptus. The flavor can be quite strong making it a good substitute for salt.

Sage is delicious in savory autumn dishes such as roasted squash, sweet potatoes, and sauces. Add it to flavor meats, bean dishes and other grains either on its own or paired with other herbs.

Sage is another herb that does not lose its flavor with long cooking, perfect for adding to a simmering sauce or higher temperature dishes.


Garlic is often associated with Italian dishes but can be used almost on anything. It is a pungent relative to onion and adds tons of sodium free flavor.

You can cut back on salt and the double the amount of garlic in recipes for tomato sauces and marinates. Garlic is great in soups and stir fries.

Garlic is a staple in many households and works with so many herbs and spices. Don’t be afraid to add a little to soups, salads, vegetables, and sauces. A little roasted garlic added to twice baked potatoes, and you will not miss the salt, cheese, or bacon!

Black Pepper

The minute you hear pepper you think salt, but pepper has enough flavor to stand on its own. It does not need salt add depth and flavor to dishes. Almost every household has ground black pepper in the kitchen and most likely in a shaker on the dining table.

Black pepper is a great addition to soups, roasts, pastas, and other savory dishes. Added to eggs, grains, or vegetables. Some people like a little pepper on their watermelon or other fruits. It is worth experimenting with. Adding whole peppercorns to a simmering or roasting dish will add a lot of flavor and look nice when serving the dish by spooning some the roasted peppercorns over it.

Pepper can add a little kick to your dish, best to start with less and add to find your perfect “kick level”. You can also try white pepper, peppercorn mixtures, or pepper alternatives like chili peppers and cayenne peppers for some added spiciness.

The bottom line

Salt has always been the go-to seasoning in most kitchens, but we consume too much of it.

Be mindful of your intake of higher-salt foods like processed meats, canned goods, sauces, soups, and condiments. Choose salt free or reduce sodium when possible. Use the seasonings mentioned in this article to replace added salt in the kitchen and at the table. Use different herbs and spices to take your familiar dishes in a whole new direction. Not only will you discover new flavors, but your heart will thank you.

For more herbs and spices to use instead of salt the National Heart, Lung, and Blood Institute published this handy guide –  Use-Herbs-and-Spices-Instead-of-Salt.

You and Your Healthcare Provider



For many, sharing person health details with their doctor can be uncomfortable. One of the most import factors in your relationship with your healthcare team is honesty.

In a 2018 study as many 80% of all patients lie or withhold information from their providers. Surprisingly a survey of 300 US adults in 2015 by ZocDoc found that women are more likely to lie or omit information during a doctor’s appointment. The same study showed that respondents over the age 65 avoided raising issues their doctor because they felt it was not serious or worth discussing.

Why patients do not share all health information

Alpine Cardiology - Female doctor with male patient

The 2018 study identified many reasons why a patient may lie or omit health information. The most cited reason was that they did not want to be judged or lectured about their behaviors. They also did not want to hear how bad their behavior/habits were for their health and want their providers to like them. For others they were simply embarrassed about their choices, didn’t want the information in their medical records or not wanting to waste their doctor’s time.

What do patients lie about?

Alpine Cardiology - Female doctor with female patient outsideThe simple answer is just about everything, usually from shame or fear. More common lies or omission are:

• How often they follow or that they didn’t follow their doctor’s instructions
• Medication management
• Diet and exercise
• Mental and emotional state
• Their sex life
• The financial situation and how it may affect their healthcare
• Sharing all their symptoms
• Whether they smoke, have quit smoking and how many cigarettes they smoke a day
• Their alcohol consumption
• Their use of recreational drugs

Some of these may seem unimportant to your health, but all of these things play a vital to your healthcare provider to understand your overall health and risk factors.

Alpine Cardiology - Female doctor with male patient in officeYour habits and hobbies can affect your medical care


They play a big role in your health and can even impact other health risks you may experience. We all know that smoking can lead to numerous health complications and if you doctor knows you smoke, they will make decisions accordingly.

“Bad” habits are not the only things you should share with your doctor. Letting your doctor know if you participate in any type of intense physical activity is important as well.

Your doctor has seen and it all

Alpine Cardiology - doctor holding patient handMost likely your healthcare provider has experience with thousands of patients and most likely anything you say will not surprise or shock them. Your doctor is not there to judge you but to help you. They can’t provide the care you need without having all the information.

Be honest about any of your concerns

If you have concerns about a vaccination, medication, or procedure, talk to your doctor. If you have anxiety about a procedure let them know so they can address those concerns. Your healthcare provider will happily provide explanation about a procedure or information about a treatment plan because the better you understand it, the more likely you are to follow it.

Why honesty is important

Alpine Cardiology - Female doctor with female patient in office

From the information you provide your doctor suggest treatments and procedures. If they are receiving bad information those treatments and procedures may not have the expected outcome.

Research has shown that have good communication with your medical provider will lead to more appropriate medical decisions with better outcomes. When your doctor doesn’t have all the information it makes it very hard, if not impossible for your doctor to properly diagnose and treat you.


Your healthcare provider is your partner not your enemy

Alpine Cardiology - Female doctor with female patient in hospital

Your entire healthcare team wants you to live your happiest and healthiest life, in order for that to happen they need to understand your overall health and habits.

No matter the issue, your doctor can answer your questions and provide additional resources. Being honest starts a conversation which is key to building a relationship to help you live a healthy life.

Remember, Dr. Bobish and her team are here to listen to your concerns and want to provide the best care they can for you. They cannot do that if you are not completely honest with them.


Ready to start your heart-healthy diet?


7 Steps to Eating Healthy

Changing your eating habits can be tough, especially if you are dealing with the stress of medical issues. When we are under stress, we tend to gravitate toward our comfort foods that are not heart heathy. You can eat well and healthy. Understanding which foods, you should eat more of and which foods to limit can help make the change to a healthy diet easier.

Controlling your portion size

Grilled Chicken

Portion control is more than just limiting how much you eat it is about understanding what a serving size (portion) actually is. In today’s world of mega size, super-size and 2 for the price of one, no wonder we struggle to eat healthy.

One of my favorites ways to control my portion size but still feel like I am getting a “full plate” of food is to use smaller plates or bowls. Seems silly, but numerous studies have shown that if our eyes see a full plate, we do not feel deprived and are more likely to be satisfied after one plate.

Read serving sizes and try to follow them. Pasta and rice serving is about the size of a hockey puck. Lean meat should be about the size and thickness of a deck of cards. Being able to judge serving sizes will take practice, use measuring cups, spoons, or a scale until you are confident in serving the right portions.

Add more fruits and vegetables.

Another trick is to fill your plate with low-calorie, nutrient-rich foods such as fruits and vegetables. Eating more vegetables and fruits may help you cut back on higher calorie foods.
Keep vegetables and fruits washed and cut in your refrigerator. These are perfect to grab when you are craving something sweet or crunchy.

We all know that eating fruit and vegetables are good for us and that they are a good source for vitamins and minerals. Did you know that like other plant-based foods, they contain substances that may help prevent cardiovascular disease?

Choose whole grains

Whole Grain Pasta

Whole grain products can be a good source of fiber and other nutrients. They can also play a role in regulating blood pressure and heart health. It is easy to increase the amount of whole grains in your heart healthy diet simply by substituting for refined grain products.

If you want to try something new add barley into your diet. Barley contains about three times as much fiber as a serving of oats. It is rich in a soluble fiber known as beta glucan and is recognized for its cholesterol-lowering abilities.

Watch your fat

You know you have to watch how much saturated and trans fat you eat. This is important to reduce your blood cholesterol and lower your risk of coronary artery disease. High cholesterol can increase your risk of heart attack and stroke.

Limiting how much saturated and trans fats you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease. A high blood cholesterol level can lead to a buildup of plaques in your arteries, called atherosclerosis, which can increase your risk of heart attack and stroke.

AvocadoThe 2020-2025 Dietary Guidelines for Americans recommend limiting saturated fat to less than 10% of total daily calories. To help meet this goal try some simple ways to cut back on saturated and trans fats:

• Trim fat off your meat or chose lean cuts of meat.
• Use less fats when cooking and serving.
• Choose low-fat substitutes when possible. Try low-sodium salsa or low-fat yogurt on your baked potato or sliced whole fruit or low-sugar fruit spread on your toast.
• Check food labels, even those that say reduced fat. Many may contain trans fats. Trans fats may be listed as partially hydrogenated oil on the label.

Sometimes you need a little fat, in those times choose monounsaturated such as olive or canola oil. Polyunsaturated fats found in certain fish, avocados, nuts, and seeds can be a good choice as well. Remember to use sparingly, all types of fat are high in calories.

Try for low-fat protein sources

SalmonLean meats, poultry and fish are great sources of protein. Choose skinless chicken and fish that are rich in omega-3 fatty acids, such as salmon, mackerel, and herring.
Low-fat dairy and eggs provide good protein as well. Look for lower fat dairy options such as skim milk, low or non-fat yogurt.

Another great source of protein that is low-fat and cholesterol free is legumes. Beans, peas, and lentils are great substitutes for meat and help to reduce your fat and cholesterol intake and increase your fiber intake.

Limit salt

Salt shakerLimiting how much sodium is in your diet is an important part of a heart healthy diet. The American Heart Association recommends that healthy adults have no more than 2,300 milligrams (about a teaspoon) of sodium a day. Ideally, most adults should not exceed 1,500 milligrams daily.

A good practice is to not add salt when you are cooking. Taste your food before adding a little salt. Also experiment with salt substitutes or fresh herbs and spices to add flavor to your dishes.
The biggest culprit of sodium in our diets are canned and processed foods. Eating fresh foods or making your own can help you control the amount of salt in your diet.

If you are using canned foods or prepared meals look for ones with no added salt or reduced sodium. Again, read the labels for the about of sodium per serving.
Meal plan

Plan your heart healthy diet for the week, make a list and stick to the list when shopping. When preparing your meal, make extra servings and freeze them to use on those days when you do not feel like cooking. This may help you avoid reaching for an unhealthy option.

Do not deprive yourself!

Allowing yourself an indulgence every now and then is okay. This may help you stick to your heart healthy diet if you know that an occasional treat will not derail your plan. If indulgence is the EXCEPTION, rather than the rule, things will balance out over the long term. Eating healthy the majority of the time is what is important.

Check with your Medical Provider

As always you should talk with your doctor about a heart healthy diet plan that is right for you.

For more information print our Food to chose and avoid to help you make the right choices.

Bowl of Vegetables

Tips for heart patients in the heat

Seniors with granddaughter walking outdoors. People in summer.


If you are a heart patient, especially if you are older than 50 or overweight, you should take special precautions in the heat.

Healthy Senior Couple Exercising In Garden TogetherBefore starting an exercise routine check with your healthcare professional and discuss any concerns you may have. You also want to talk about the medication you are on. Certain heart medications like beta blockers, ace receptor blockers, ace inhibitors, calcium channel blockers and diuretics (which deplete the body of sodium) can exaggerate the body’s response to heat.

Whether you are on medications or not, older people should take care in the heat. If you are going to be outside, it is important to drink water even if you do not think you need it. At the point you are thirsty, you are already dehydrated.

Everyone can maintain an active and healthy lifestyle regardless of the temperature outside, just make sure you take the proper precautions.


senior walking exerciseTips for everyone

Ready to brave the heat? It is best to avoid the outdoors in the early afternoon (around noon – 3pm). The sun is usually at its strongest and puts you at a higher risk for heat-related illnesses. Early in the day or evenings are great times to get outside and walk, garden, swim, or any outdoor activities. You can also take advantage of air-conditioned facilities like a mall or indoor track to walk when temperatures soar. Remember the buddy system, exercising with a friend is fun and safer.

More tips for staying comfortable and safe in the heat.


Something many do not think of is that we sweat a lot in our shoes. You want well-ventilated shoes and socks that repel perspiration. Keeping your feet comfortable in the heat makes for a more enjoyable time outside.

Dressing for the heat is important. You want to wear lightweight and light-colored clothing in breathable fabrics such as cotton. Synthetic fabric that repels sweat is a great option too.

Active and sporty senior couple engaging in healthy sports activiesDo not forget to protect your head and eyes. A stylish hat will not only look great but protect your scalp and provide some shade for your face. Sunglasses are important to protect your eyes from the sun. Use sunscreen with at least an SPF of 15 to any exposed skin and reapply it every two hours.

Hydrate, hydrate, and hydrate! Drink water before, during and after you go out in the heat. Avoid caffeinated and alcoholic beverages both can contribute to dehydrated.

Take regular breaks and rest. Relax in some shade or a cool place for few minutes, hydrate and continue. Just because temperatures may be high you can still exercise and enjoy outside, adapt, and stay safe.

Symptoms of heat exhaustion:

  • Headaches
  • Cool, moist skin
  • Dizziness and light-headedness
  • Weakness
  • Nausea and vomiting
  • Dark urine

If you experience these symptoms, move to a cooler place, stop exercising and cool down immediately by using cool wet cloths, compresses, and fanning. You may need to seek medical attention.

Symptoms of heat stroke:

The symptoms of heat stroke include (call 911 or the local emergency number right away):

  • Fever (temperature above 104 °F)
  • Irrational behavior
  • Extreme confusion
  • Dry, hot, and red skin
  • Rapid, shallow breathing
  • Rapid, weak pulse
  • Seizures
  • Unconsciousness

Consult your Doctor

Your doctor is a partner in helping you stay healthy and active; they can advise you about your specific needs. Your healthcare provider can help you choose activities that will help your heart and are safe for you.

Being active is part of your heart-healthy lifestyle. Along with a heart healthy diet, exercise may strengthen your heart muscle, lower your blood pressure and cholesterol, and help keep your bones strong. Regular exercise can help you lose weight and feel better.

If you are new to exercise start slow and build up gradually little by little. Remember the more exercise you can the healthier you and your heart will be. Any amount will help.

Side view of a man doing a stretching exercise with the help of his yoga partner

© 2021 Alpine Cardiology, All Rights Reserved