Hearts represent the Lamb's lifeforce. Each hit takes away one half of a heart, unless the Golden Fleece is worn, or you are in a combat area with the "enemies have ½hp you take 2× damage" modifier, in which case one full heart will be lost.
There are three types of health:
Red Hearts are standard health and can be restored with health pickups or Vampiric weapons. Base amount of your Red Hearts depends on difficulty, with Sermon upgrades providing a total additional heart permanently. Additional, non-permanent Red Hearts can be gained from certain Tarot Cards while on a Crusade. All Red Hearts come in their own Heart Container, which can be restored at a Health Pool or by picking up more Hearts from the floor. There's also the Spirit Hearts variation that has a golden border, and becomes fixed extra hearts during the Crusade.
Blue Hearts work almost exactly like red ones, but will be lost upon finishing your crusade. Care must be taken as once the Heart is lost during your crusade it is gone forever, and to gain more you must draw a relevant card or find them as a drop; they do not come within Heart Containers like Red Health.
Diseased Hearts or Black Hearts are similar to Blue Hearts in that they will be lost post-crusade and cannot be normally restored by standard healing. They have a unique mechanic where taking damage will deal damage to all enemies on the screen when lost.- Spirit Heart are temporary hearts given as powerups on crusades. They will disappear after finishing a run or dying.
If the Lamb takes damage, hearts are taken away beginning with Diseased Hearts; then Blue Hearts; and finally Red Hearts. After a run ends your Red Hearts will be fully reset and all special hearts will be lost.
There are multiple ways of obtaining more hearts of each type prior to starting a new crusade. None except for the Red Hearts are truly permanent and a task must be performed to receive Blue and Diseased Hearts after you finish your crusade, unless granted by a Fleece.
| Type | Location | How to obtain | Additional notes |
|---|---|---|---|
1/2 to 1 Spirit Heart
|
Unlock Empowered Shrine with Divine inpiration | Fill up the Empowered Shrine of Disciples. Disciples pray to the shrine about 10 times. | It is a temporary red heart with a yellow ring around it, It will disappear after death on a crusade. Spirit Hearts will not unlock the ancient tablet rooms. |
1/2  Red Heart
|
Your temple, skill tree | Hearts of the Faithful I and II give 1/2 Red Heart, each. | Both of these upgrades are permanent. |
| 1/2 Red Heart
|
Crusade, Ratoo's room | Offering a follower that has turned into Hathor to Ratoo upon finding him in his heart shaped room. | You will permanently lose this follower! Can only be done once. This upgrade is likewise permanent. |
1  Blue Heart
|
Your temple, crown upgrade | Obtain a Heart of a Heretic and use it to receive The Hunger, a crown upgrade. Eating a normal meal thereafter will grant you one Blue Heart. | You can only eat one meal for this effect. It does not stack and cannot be repeated until after a crusade. It also does not stack with the two Diseased Hearts that can be obtained in this manner. |
| 1 Blue Heart
|
Your temple | You gain one Blue Heart after each sermon. | Can be repeated as many times as you like but only once a day. Requires the Sermon skill tree to be fully maxed out. |
| Blue Hearts
|
Your temple, fleece upgrade | Gather 4 fragments of the Holy Talisman, then unlock & wear the Fleece of Fragile Fortitude. | All Red Hearts are removed, and for each heart you gain Blue Hearts at a 2:3 ratio. |
2  Diseased Hearts
|
Your temple, crown upgrade | Obtain a Heart of a Heretic and use it to receive The Hunger, a crown upgrade. Eat Minced Follower Meat to receive 2 diseased hearts. | You can only eat one meal for this effect. It does not stack and cannot be repeated until after a crusade. It also does not stack with the one Blue Heart that can be obtained in this manner. |
| 1 Diseased Heart
|
Your temple, crown upgrade | Obtain a Heart of a Heretic and use it to receive Darkness Within, a crown upgrade. | Receive one Diseased Heart upon starting a crusade. |
| 1 Diseased Heart
|
Your temple, fleece upgrade | Gather 4 fragments of the Holy Talisman, then unlock & wear the Fleece of the Diseased Heart. | 1 Diseased Heart is given upon drawing a tarot card. This does not stack, however, it can be repeated upon losing the Diseased Heart prior to drawing another tarot card. This can only be done during a crusade. |