Due to disabled life regeneration, Iron Heart would be used to trigger certain effects that only happened when below certain amount of health such as Necklace of Vexation, or Old Duke's Scales. The Bloodflare Core could heal the player while Iron Heart was active, as it healed the player directly instead of increasing life regeneration. Fall damage, thorny bushes, and (wooden) spikes were unaffected by Iron Heart's damage floor, but Traps were affected. Permafrost's Concoction, the Nebulous Core, and the Draconic Elixir's revive effects could still restore the player to their set health amounts while Iron Heart was active. The damage multiplier applied to the player by the Blood Pact's critical hits and the Dimensional Soul Artifact were applied after Iron Heart's damage floor. Hearts, the Nurse, and Lifesteal effects would still heal the player even while Iron Heart was active. 
This means that all players that join a world in which the Iron Heart had been used would have the Iron Heart's effects, even if they didn't use the item. The Iron Heart's effects were tied to the world it was used in, rather than the player that used it.A softer version of the hit sound played if the taken damage was below (and therefore increased to) the damage floor, and a louder version played if the damage taken was above the damage floor.
The player would have custom hit and death sounds. They remained with this appearance even after using Life Fruits or other permanent power-ups. The player's life hearts would become light gray in appearance, with black 'eyes' on either side of each, matching the appearance of being heart-shaped skulls. Defense, however, was applied after Iron Heart, and could reduce the amount of damage taken in one hit to below the damage floor. Damage Reduction was applied before Iron Heart's damage floor it could only reduce the base damage of the attack taken down to that floor. Hits that would deal more damage than this minimum would deal their normal damage. The damage floor was calculated as 40 + 10% of the player's max HP. Direct damage taken by the player dealt a minimum amount of damage, dependent on the player's max HP. #Hollow.knoght black geyser full#
Damaging debuffs, however, were unaffected by this, and would deal full damage regardless of the player's hidden life regeneration. If the player was under effects that decreased life regeneration (such as the Drunk Princess' Drinks, Mana Polarizer, or Ethereal Extorter), life regeneration bonuses were able to offset them up to the point where they dealt no damage.Natural Health regeneration couldn't increase beyond 0, preventing the player from naturally healing over time.
Upon being used in Expert Mode, it enabled or disabled several effects on every character in the current world: The Iron Heart was an item placed in a newly spawned player's inventory.
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