George H.W. Bush: Atrial Fibrillation

atrial fib
While jogging at Camp David on a Saturday afternoon (May 4, 1991), Bush developed shortness of breath, chest tightness, and a general feeling of fatigue. A White House physician discovered Bush had a rapid irregular heartbeat, ultimately diagnosed as atrial fibrillation due to hyperthyroidism (see below). 1 SEE BELOW

Bush was transferred to Bethesda Naval Hospital by helicopter. His ventricular rate was 150/min 2a. Cardiologist Dr. Allen M. Ross prescribed digitalis, procainamide, and Coumadin 1. (Note: Digitalis slows the heart, procainamide can change the rhythm pattern from atrial fibrillation back to normal, and Coumadin prevents blood clots, one of the main complications of atrial fibrillation.) Abrams writes:

According to the doctors' plan, if the drugs failed to affect the arrhythmia -- as initially they did -- an electrical shock would be administered the following day, a common way of returning a patient's rhythm to normal. When it was announced that Dan Quayle would be acting president under the Twenty-fifth Amendment provisions while Bush was under anesthesia for the cardioversion -- if it was required -- a different kind of shock reverberated across the nation. The prospect of Quayle as president brought home sharply the electorate's lack of confidence in his ability to lead. 3a
The drugs were effective. By 10:25 pm on May 5, Bush's heart rhythm was normal. About 5 am the following morning, however, atrial fibrillation recurred. It was decided (by whom?) to continue the drugs rather than use electrical cardioversion. Bush returned to the White House later that day. 3a. Comment: It would be useful to have information on how long Bush used these medications. Both digitalis and procainamide can affect higher mental function.
The following statements 4 were issued by the White House in the wake of Bush developing atrial fibrillation.

(The number in square brackets after the date of each statement is the document number used by the Bush Presidential Library.)

Statement by Press Secretary Fitzwater on the President's Health
May 4, 1991 [91050402]

President Bush is relaxed, comfortable, and having dinner with Mrs. Bush in his room at Bethesda Naval Hospital this evening. He is in good spirits and the doctors' reports are very positive.

President Bush developed atrial fibrillation, which is an irregularity of the heartbeat, while running at Camp David this afternoon about 4:20 p.m. This condition presented itself as unusual fatigue during the run. The President was evaluated by Dr. Michael Nash at Camp David, who detected the irregular heartbeat and found him to be entirely stable with no other symptoms.

The President, accompanied by Mrs. Bush and Dr. Nash, flew by helicopter to Bethesda Naval Hospital, arriving about 5:58 p.m. this evening. At the time of hospital admission, the irregular heartbeat was still present, but the President was completely alert and entirely stable, with no complaints. The President walked into the hospital on his own power.

An electrocardiogram showed no abnormalities except the irregular heart rhythm. An ultrasound examination of the heart showed no structural abnormalities and normal heart function.

The President is undergoing treatment for atrial fibrillation with the drug digoxin. Diagnostic testing and initial treatment took approximately 1 hour. The President has been consulting with Governor Sununu on various issues at the hospital. The President will remain there for observation over the night.

Physicians in attendance are Dr. Lawrence Mohr, colonel of the U.S. Army; Dr. Michael Nash, major, U.S. Air Force, of the White House Medical Unit; and Dr. John A. Williams III, lt. commander, U.S. Navy, a staff cardiologist at Bethesda Naval Hospital.

Mrs. Bush will remain with the President at the hospital overnight. Vice President Quayle spoke with the President by telephone about 7:20 p.m. and found him in excellent spirits.

Note: The Press Secretary read the statement to reporters at 8:30 p.m. in the Briefing Room at the White House. John H. Sununu was Chief of Staff to the President. Later in the week, the President was diagnosed as having Graves' disease.

Statement by Press Secretary Fitzwater on the President's Health
May 5, 1991 [91050500]

The President spent a comfortable night, sleeping well. He awoke at 6 a.m., did paperwork, and spoke with Governor Sununu by phone.

The President is in great spirits, but still has atrial fibrillation. There are no signs of heart damage and no evidence of a heart attack. The President has no other symptoms and feels completely normal. This is corroborated by the blood and x-ray tests which were examined this morning.

The President continues to take digoxin for the atrial fibrillation. This is now being supplemented by the drug procainamide, which is a normal procedure in such cases. The President will remain at the naval hospital today for observation on the drugs.

The President's Physician, Dr. Burton Lee, is supervising the team of physicians who are attending to the President. Dr. Bruce K. Lloyd, captain, U.S. Navy, chief of cardiology at the naval hospital, is directing the President's care. Dr. Allan Ross, chief of cardiology at George Washington University Hospital, is consulting on the President's case.

Mrs. Bush spent the night at the hospital and departed for the White House a little past 7 a.m. She will return to the hospital later today.

The President received a call from Vice President Quayle early this morning, before the Vice President went to church.

The President also spoke this morning with General Brent Scowcroft, his national security adviser; Secretary of State Baker; Secretary of Defense Cheney; and Secretary of Commerce Mosbacher. These were personal calls. There have been no special security concerns.

General Scowcroft and Governor Sununu will meet with the President about mid-morning to provide their routine national security briefing and to discuss other policy matters.

The President also spoke this morning with his son Marvin and his daughter, Dorothy.

The President has received a number of messages from world leaders wishing him good health.

Note: John H. Sununu was Chief of Staff to the President.

Statement by Press Secretary Fitzwater on the President's Health
May 5, 1991 [91050501]

President Bush's diagnosis today remains essentially the same as last night. He continues to take digoxin and procainamide for the atrial fibrillation. While there have been some indications of a positive response to the medicine, the President's heartbeat has not returned to its normal rhythm. The President is wearing a heart monitor and the doctors continue to watch his progress.

In order to allow continued observation of the President, he will remain overnight at Bethesda Naval Hospital. Mrs. Bush has returned to the White House. The President has spent a relatively active day at the hospital, conferring with Governor Sununu, General Scowcroft, his doctors, Mrs. Bush, and other friends that he has called. He visited with his son Marvin and his daughter, Dorothy, at the hospital, as well as his grandchildren Sam and Ellie LeBlond.

The President's medical team met for nearly 2 hours this evening, from 4 p.m. to 6 p.m., to discuss the latest test data. They report that the President is in fine condition, good spirits, and showing some response to the medicine. They will review the President's progress again tomorrow morning, perhaps as early as 5 a.m. or 6 a.m.

The doctors report that atrial fibrillation can last for varying periods of time, sometimes only a few hours, sometimes longer. It is a condition that must be continually analyzed, but can be treated in a number of ways. Because the President is now entering his second day with this heart irregularity, there has been considerable speculation about courses of medical treatment. We want to assure the American people that the President is in a healthy condition. He has not suffered a heart attack. He has not suffered heart muscle damage.

We remain hopeful that the medication will return his heart to normal rhythm. If by morning that is not the case, the doctors will consider electricalcardioversion. This procedure is well-known and relatively commonplace. The risk is minimal, particularly in a patient such as the President who has no demonstrable heart disease. Nevertheless, it would require general anesthesia, which would be expected to incapacitate the President for only a short period of time. The final decision on this will be made tomorrow morning. During the short time that the President would be under anesthesia, the Vice President would be Acting President under the 25th amendment.

Once again, I want to emphasize that we hope that the President will respond to his medicine in a way that returns his heartbeat to normal and no further treatment will be needed. The doctors will make that evaluation early tomorrow morning.

Note: The Press Secretary read the statement to reporters at 9:02 p.m. in the Briefing Room at the White House. John H. Sununu was Chief of Staff to the President, and Brent Scowcroft was Assistant to the President for National Security Affairs.

Statement by Press Secretary Fitzwater on the President's Health
May 6, 1991 [91050600]

At approximately 10:45 p.m. last night, the President resumed his normal heart rhythm, which was maintained until 4:45 a.m. this morning, at which time atrial fibrillation reoccurred. The attending physicians met at 5:30 a.m. this morning for approximately 2 hours to consider the situation. It was deemed unnecessary to carry out the electrical procedure since the President's response to medication had been encouraging. They decided instead to continue further adjustment of his medication and maintain observation of the President while working here at the White House.

President Bush will be discharged at approximately 9 a.m. this morning and return immediately to the Oval Office. His progress will be monitored here as his medication levels and dosages are observed. It should be stressed again that there continues to be no evidence of organic heart disease.

Today the President will continue his normal responsibilities and activities. He will meet with former Soviet Foreign Minister Shevardnadze at 1:30 p.m. and will conduct other business during the day.

The President rose at 5:20 a.m. this morning. He's in good spirits and anxious to get back to work. We look forward to having him back in the White House very soon.

Note: The Press Secretary read the statement to reporters at 8:38 a.m. in the Briefing Room at the White House.

Exchange With Reporters in Bethesda, Maryland, on the President's Health
May 6, 1991 [91050601]

Q. Mr. President, what do you think?

The President. I feel all right. I've just got to get over and get back to work, and keep a little monitor going here.

Q. Have you had to change your lifestyle at all or -- --

The President. Go ahead and ask the doctors that, but not as far as I'm concerned.

Q. Are you going to lighten up at all for the next few days?

The President. Well, they said to gradually get back into the athletics and not overdo it, so we won't run today.

Q. [Inaudible]

The President. No, it's not caused by jogging. But you ask the doctors; they'll tell you all that. I don't want to get a bad rap on the joggers.

Q. -- -- any particular stress situation?

The President. No. Ask the doctors, because I don't even know that that's the cause.

Q. But is it right now, sir, is your heart beating regularly?

The President. No, it's not in normal rhythm. Ask the doctors what all that means. I've never heard of this stuff before Sunday.

Q. Are you concerned about that at all?

The President. No. If I were concerned I wouldn't be here, I'd be up there.

Note: The exchange began at 9 a.m. on the grounds of Bethesda Naval Hospital, prior to the President's departure for the White House. A tape was not available for verification of the content of this exchange.

Exchange With Reporters
May 6, 1991 [91050602]

President's Health

Q. What did the doctors say?

The President. They're going to have a press conference at 9:30 a.m., I think.

Q. Will you cut back on your schedule at all?

The President. Not much. Kind of work back into it. But I think it's okay.

Q. What about jogging?

The President. Well, we can start again -- he said today if I want to, but I'm not sure I feel up to it yet.

Vice President

Q. What do you think about all the talk of the competence of Vice President Quayle that's been revived?

The President. Hey, he has my full support, always has, and he's doing a first-class job.

Hey, listen, it's great to be back.

Note: The exchange began at 9:20 a.m. in the Rose Garden at the White House, upon the President's return from Bethesda Naval Hospital.

Statement by Press Secretary Fitzwater on the President's Health
May 6, 1991 [91050607]

President Bush has carried out his normal schedule for the day, indicating several times that he felt well and is glad to be back at work. The President is cheerful and absorbed by conversations with visitors to the Oval Office, often indicating that he feels in the best of health. The President's heartbeat remains in normal sinus rhythm, which means that there is no irregularity.

The White House medical staff continues to monitor the President's heartbeat on a regular basis. A heart monitor has been set up near the President's study just off the Oval Office. A White House nurse checks the President's heartbeat with the monitor between meetings and at other times when the President is not otherwise occupied. During the course of the day, the President's heartbeat has shown no evidence of returning to fibrillation. Monitoring in the days ahead will be done by telemetric EKG equipment.

The intravenous line was removed from the President's arm late this afternoon. The bandage remains only to close the point of insertion. The President remains on digoxin and procainamide.

According to the President's Physician, Dr. Burton Lee, ``The President's medical day in the White House has been uneventful. He has performed the functions of office while maintaining good humor and good health. No problems of any kind have arisen since he left the hospital.''

Exchange With Reporters on the President's Health
May 7, 1991 [91050701]

Q. Mr. President, how are you feeling, sir? And is your heartbeat back to completely normal?

The President. Back to normal, and I'm feeling great. And this is a photo op at which I do not take questions. [Laughter] Same old me. Thank you for inquiring.

Note: The exchange began at 10:23 a.m. in the Cabinet Room at the White House. A tape was not available for verification of the content of this exchange.

Cited Sources
  1. The Thyroid Society. Graves' disease: the heart of the matter. [On line]. Accessed 16 December 2002.

    Comment: See:

  2. Bumgarner, John R. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: MacFarland & Company, 1994.
    a  p.292

    Comment: Devotes one chapter to each President, through Clinton. Written for the layperson, well-referenced, with areas of speculation clearly identified, Dr. Zebra depends heavily on this book. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book casting a physician's eye on that experience.

  3. Abrams, Herbert L. "The President Has Been Shot": Confusion, Disability, and the 25th Amendment in the Aftermath of the Attempted Assassination of Ronald Reagan. New York: W. W. Norton & Company, 1992.
    a  p.261

    Comment: Rigorous and enormously thought provoking. Abrams tells not only the story of the shooting itself, but, more importantly, the maneuvering to disguise Reagan's slow recovery afterwards and forestall any consideration of transferring power to the Vice President.

  4. White House Press Release. [various topics]. George H.W. Bush Public Papers. (Kept in the Bush Presidential Library, College Station, TX).

    Comment: Downloaded 26-27 November 2003 from:

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