Bush Returns to a Full Workday : Presidency: He is back in the White House as his heart responds to medication to restore normal pattern.

WASHINGTON —  With his heart responding to medication intended to slow it down and restore it to a normal rhythm, President Bush returned to the White House Monday and plunged immediately, and visibly, into a long day of Oval Office meetings.

“I feel all right,” Bush said as he walked out of Bethesda Naval Medical Center after spending 39 hours there.

Adhering to the Monday schedule that had been prepared for him last week, before he complained of fatigue and shortness of breath while jogging Saturday afternoon at Camp David, Md., Bush met with President Paul Biya of Cameroon, former Soviet Foreign Minister Eduard A. Shevardnadze, and former Sen. Rudy Boschwitz (R-Minn.), among others.

He appeared relaxed and animated, if slightly tired--and he acknowledged to the approximately 150 White House staff members who greeted him in the Rose Garden on a rainy morning that he did not yet feel up to going for a jog.

As he was leaving the hospital, his heart again began its irregular pace before returning to normal a short time later. But Dr. Burton Lee, the President’s physician, said at the end of the day that “no problems of any kind have arisen since he left the hospital.” A White House statement said the President’s heartbeat continued in a normal pattern during the afternoon.

Between his meetings, the President’s heart was checked by a White House nurse who used a heart monitor set up just outside the Oval Office.

Several times Bush indicated “he felt well and is glad to be back at work,” White House Press Secretary Marlin Fitzwater said.

His doctors said they were placing no restraints on his activities--he has out-of-own trips planned Friday, Sunday and Monday--nor on his typically vigorous athletic pace after they adjust the level of his medication.

His pulse rate was said by his doctors to have been in the mid- to upper-90s when he arrived at the hospital, elevated from his normal rate in the mid-60s to low-70s.

“I intend to gradually get back into the athletics and not overdo it. So we won’t run today,” Bush said.

“He can be expected to live the same life he was living last week,” said Dr. Allan Ross, chief of cardiology at George Washington University Medical Center and a member of the team that is treating the President.

Barbara Bush told reporters Monday that the discomfort the President felt while jogging “was so minor that he almost didn’t go see the doctor. He was just a little short of breath. He didn’t feel sick. No pain.”

Later, she said, he complained at the hospital that he should not have reported his fatigue to accompanying Secret Service agents, telling her: “I wish I hadn’t done that. I could be up at Camp David still.”

Mrs. Bush also said her husband had experienced similar symptoms on a previous run.

Presidential physician Lee confirmed this, saying “we didn’t do any tests. By the time I got to him, he was completely normal.” He noted that it was a hot day and it was the beginning of the season, so he thought it was not cause for alarm.

The President’s physical exams over the weekend included two echocardiograms, to study the structure of his heart and its muscle function, “all of which were normal,” said Capt. Bruce K. Lloyd III, chief of cardiology at the Navy hospital.

Within the medical community, there was debate about whether Bush was ready to head home and, indeed, whether doctors should have used an electrical procedure, known as cardioversion, to shock his heart back into a normal rhythm.

Bush’s doctors had considered the procedure, but said the success of medication made that step unnecessary.

“It was pretty unequivocally de cided this morning at 5:30 a.m. or 6 a.m. that there was no reason that the President could not go home. It’s easier when it’s the President because there’s such a superb staff around him,” said Ross.

But Lee conceded a less prominent patient might have remained hospitalized longer.

“If he’s Joe Blow, you’d be much less happy about it,” he said of the discharge.

Dr. Douglas Zipes, professor of medicine at the Indiana University school of medicine and a cardiologist at the Krannert Institute of Cardiology, said he probably would have kept Bush in the hospital because the President had had a relapse while hospitalized and under medication.

The arrhythmia, known as atrial fibrillation, disappeared at about 10:45 p.m. Sunday, Bush’s doctors said, and returned at 4:45 a.m. Monday. It was occurring as Bush headed out of the hospital and back to the White House, but it vanished about 25 minutes after he reached the Oval Office at 9:20 a.m., the doctors said.

“I’d like to know that his heart rate is well-controlled,” Zipes said. “It may be, but I think it (the discharge) was premature. But it could have been the press of political decision-making things he has to do.”

Bush’s doctors said their decision was based purely on medical considerations. Lee said White House Chief of Staff John H. Sununu attended the early morning meeting at which it was decided that Bush could go home, but he “didn’t really do much more than listen.”

“Needless to say, the President wanted out,” Lee added. “He’s not a guy who likes to lie around a room.”

Dr. George Bren, a cardiologist in private practice in Washington who is associated with George Washington University Medical Center, said that the fact that Bush relapsed--that his heartbeat had stabilized and then reverted to fibrillation--suggests that this may not be an isolated episode for the President.

“It implies that his heart has some ongoing tendency to develop fibrillation,” Bren said.

Experts stressed, however, that they expected Bush to resume his normal vigorous activities and would encourage him to do so.

“Atrial fibrillation does not impose a significant constraint on the lifestyle in people with otherwise healthy hearts,” said Dr. Jeremy Ruskin, director of the cardiac arrhythmia service at Massachusetts General Hospital in Boston.

Cardiologist Lloyd said that once Bush’s medication level is “adjusted appropriately, we will encourage the President to resume all his normal activities at full speed. That could be as soon as a few days from now.”

Lee pointed out that the relapse into atrial fibrillation occurred while the President was in a deep sleep early in the morning, and that the condition was not invariably connected with exercise.

Bush is being given two drugs, digoxin and procainamide, in pill form to counteract the arrhythmia. Digoxin is given to slow down the heart rate and procainamide is used to correct electrical abnormalities responsible for heart rhythm disorders. The medications produce nausea and vision problems in some patients, but Bush was said by his physicians to be experiencing no side effects.

Times staff writer Marlene Cimons contributed to this story.