2) Carditis: Inflammation of the heart (carditis) affects all layers of the heart, although it is inflammation of the endocardium--the innermost layer, including the valves--that has the most adverse consequences. The development of a murmur, due to valve dysfunction, may be the only sign of cardiac inflammation. However, echocardiography may be used to confirm carditis. Chest pain and friction rub (a high frequency scratching or squeaking sound made by the inflamed pericardial membranes) may occur as a result of pericarditis.