Hell Game is an unlockable machine in The Binding of Isaac, added in the Repentance DLC.

Costs half a heart to play. Prioritizes red hearts first.

Starting from Chapter 4, costs a full heart to play.

Not having enough HP to play can kill Isaac.

When given a heart, the beggar will lift one of the skulls up, revealing a Black Heart, Blue Spider, bomb, item, key, coin, or card. He will then shuffle the skulls around and wait for Isaac to bump into one of them, which will result in a payout.

The skull Isaac bumps into is not relevant.

Leaving the room before bumping into a skull will reset the prize.

If a Devil Deal has been taken during the run, there is a 25% chance that a Shell Game will be replaced with a Hell Game.

Possible payouts
• 2 of the previously shown pickups, 1 if it was a Black Heart or a card, or 2-3 if they were coins.
• Enemy Spider.

Final payout
• Random item from the Devil Room item pool.

When destroyed
• Spawns 2 Enemy Spiders.

This page shows the latest information as of the new Repentance+ (Online Co-op) DLC.
To see information about this machine for the previous Repentance version, check this page instead.

Defeat Mega Satan as Tainted Azazel.

The following special synergies and interactions for Hell Game have been documented.

* Note that not all possible synergies and interactions are listed here.

• Check out the machine description on the external Isaac Wiki.