Rheumatic heart disease does not cause cold joints during an attack. The main clinical symptoms are primarily heart failure or arrhythmias. However, due to the underlying rheumatic heart disease, there is rheumatic fever. If it is in the acute phase of rheumatic fever, cold joints, swelling, and pain may occur. It is necessary to conduct further tests including rheumatic factor, erythrocyte sedimentation rate, C-reactive protein, etc., to clarify the specific cause of the cold joints. Treatment can be directed towards the symptoms that appear. The main focus during an attack of rheumatic heart disease should be on managing heart failure and arrhythmias, maintaining heart function, reducing the burden on the heart, and controlling common arrhythmias, such as episodes of atrial fibrillation, among others.