When a patient experiences chest pain and shortness of breath, the first fear is often a heart attack. While tests and imaging can help rule that out and offer relief, they may still be overlooking a serious condition—pericarditis.

Pericarditis is the inflammation of the pericardium, the fluid-filled membrane that surrounds the heart. If left untreated, it can cause intense chest pain and lead to pericardial effusion—an accumulation of fluid around the heart that can increase pressure and become dangerous. It can also disrupt the heart's electrical activity, potentially triggering atrial fibrillation.

Early detection is difficult, especially since more than 80% of U.S. cases have no clear cause. Often, the inflammation is the result of a viral infection that has already resolved. In some cases, autoimmune diseases such as lupus, rheumatoid arthritis, or even cancer may lead to pericarditis.

At MedStar Washington Hospital Center and the MedStar Heart & Vascular Institute, advanced diagnostic tools and specialized treatment protocols help identify and manage pericarditis before it worsens. Early intervention may reduce the severity, prevent complications, and lower the chances of recurrence.

Understanding Recurrence and Symptoms

About 15–30% of patients experience recurring pericarditis. With each recurrence, the risk of ongoing and more severe symptoms increases. These may include:

  • General fatigue and weakness

  • Chest pain that worsens when lying down and eases when sitting up

  • Irregular heartbeat (too slow, fast, or skipping beats)

  • Shortness of breath

In late stages, the pericardium may stiffen, leading to constrictive pericarditis, which restricts the heart’s ability to pump efficiently. Other serious complications include cardiac tamponade, where pressure from excess fluid around the heart prevents it from functioning properly.

Current treatments focus on reducing inflammation. In advanced or drug-resistant cases, surgical intervention may be necessary. To improve outcomes, MedStar is participating in a multicenter clinical trial exploring a Cannabidiol derivative that may reduce inflammation and prevent future episodes.

How We Diagnose Pericarditis

Once a heart attack is ruled out, the next step is to thoroughly review the patient’s history and symptoms, including:

  • When symptoms began

  • Signs of recent infection (e.g., cough, fever)

  • Whether this is a first occurrence or recurrence

  • Symptoms such as shortness of breath, fatigue, and acute chest pain

Doctors may order an MRI, echocardiogram, and EKG to evaluate the heart. At MedStar, our imaging team performs over 4,000 cardiac scans annually, ensuring accuracy in diagnosis. Blood tests for inflammatory markers like ESR and CRP are also performed. High levels of these markers, in combination with symptoms, strongly suggest pericarditis.

In some cases, fluid around the heart is found by accident during imaging for unrelated issues. If the patient has no symptoms, this fluid may not be clinically significant.

Treatment Options

MedStar offers cutting-edge diagnostics such as echocardiography, cardiac MRI, and CT imaging, along with advanced medical and surgical treatment options.

First-Time Pericarditis

Initial treatment typically includes:

  • Colchicine: An anti-inflammatory drug also used to treat gout

  • NSAIDs (e.g., ibuprofen): Help reduce pain and inflammation

These drugs together can effectively manage symptoms and reduce recurrence risk. However, 15–30% of patients may still experience a second episode. Each recurrence increases the likelihood of more severe and prolonged illness.

Many patients also develop pericardial effusion during episodes. If fluid accumulates quickly or in large amounts, a procedure called pericardiocentesis may be needed. This involves using a fine needle, guided by ultrasound, to drain fluid from around the heart. It is typically reserved for emergencies or to test the fluid for causes like cancer, as the procedure itself can increase inflammation.

Recurrent Pericarditis

For patients with recurring symptoms, colchicine and NSAIDs are often not enough. Injectable treatments may be considered:

  • Rilonacept: A weekly injection and the only FDA-approved drug for recurrent pericarditis

  • Anakinra: A daily or twice-daily injection, often used in rheumatoid arthritis. Not FDA-approved for pericarditis but still effective

  • Corticosteroids: These reduce inflammation but carry side effects and may increase recurrence risk

Injections can be inconvenient, and stopping them may lead to relapse. Clinical trials offer hope for more manageable solutions.

Clinical Trial: Cannabidiol-Based Treatment

MedStar is participating in the MAvERIC Trial, a phase 2 study evaluating CardiolRx™, an oral Cannabidiol (CBD) solution. This new approach aims to reduce inflammation and possibly prevent pericarditis recurrence, without the burden of injections.

CardiolRx™ has been shown in preclinical studies to target multiple inflammatory pathways involved in pericarditis and myocarditis. The trial includes:

  • 8 weeks of treatment to measure pain reduction (on an 11-point scale) and changes in CRP levels

  • 18 additional weeks to assess if patients can taper off other medications

So far, trial participants have responded well, and researchers across sites meet regularly to review outcomes.

Eligibility Criteria

To join, patients must:

  • Be age 18 or older

  • Have had at least two episodes of pericarditis not caused by cancer or autoimmune disease

  • Show signs of pain or inflammation (e.g., high CRP levels)

Exclusion applies to patients with certain diseases, recent cannabinoid use, or immunotherapy treatments.

Looking Ahead

Recurrent pericarditis can be physically and emotionally draining. Through innovative treatments and clinical trials, we aim to shift the management of this condition from invasive, reactive care to preventive, accessible solutions. This offers patients more comfort, fewer relapses, and a higher quality of life.