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Bone Hearts have only a 20% chance of being converted. They turn into 8 Book of the Dead orbital bone familiars when picked up rather than acting as health.
Any coin dropped has a 5% chance of being converted into a Cursed Penny.
Minions
Taking damage in an uncleared room removes all adjacent hearts of the same type as the one that took damage, and converts them into minion familiars.
For example, taking Immoral Heart damage will remove all adjacent Immoral Hearts in the health bar, and turn them into purple Immoral Minions. Black Heart damage turns them into black Evil Minions.
Every full heart gets converted into a Minion, while half a heart gets converted into a Hollow Minion. Hollow minions appear with ball-like heads instead of a face.
Upon room clear, all minions convert back into the type of heart they originated from and can be picked back up again. Hollow Evil Minions, however, will disappear into a puff of smoke.
When the health conversion happens, Fiend can be left with only half a heart reamining, but never with none as it would result in death.
Minions follow enemies and deal contact damage to them. The rate at which they deal damage scales with Fiend's tears stat.
Immoral Minions deal 20% of Fiend's damage, while Evil Minions deal 40%.
Minions have a chance to perform a critical hit that deals 5x Fiend's damage. The chance is 0.4% for Immoral Minions, and 0.67% for Evil Minions.
The chance scales with luck and goes up to 10% with 12.5 luck for Immoral Minions, and 7.5 luck for Evil Minions.
If Fiend has the ability to fly, the minions will sprout wings and will be able to fly as well.
Pyromancy
Fiend has an inherent Pyromancy ability, allowing him to generate orbital fireballs that can be launched at enemies.
Unlike the regular Pyromancy item, Fiend's Pyromancy requires dealing damage in order to generate fireballs.
The amount of damage required to generate a fireball is equal to 40 + 10 * CurrentFloor.
Enemies killed by the fireballs have a 50% chance to drop a Half Immoral Heart that disappears after 2 seconds unless picked up.
Special synergies
The following special synergies and interactions for Fiend have been documented.
The Pyromancy balls become purple and gain a much stronger homing effect, as well as a chance to spawn a Half Immoral Heart upon enemy impact that disappears after 2 seconds.
The chance starts at 50% but is halved after every successful spawn, until the end of the room.
* Note that not all possible synergies and interactions are listed here.
External links
Check out the character description on the mod's external Wiki.