The Twisted Heart of Uhkeiros is one of Last Epoch’s most coveted unique relics for players looking to scale power through health-based mechanics. Its potent ability to convert missing health into bonus damage opens up devastating synergies for builds that can sustain and Last Epoch Gold manipulate their life pool efficiently. Whether you’re running a Lich, a Paladin, or even a Warlock, this unique relic creates a high-risk, high-reward playstyle that can shred through content if managed correctly.

This guide covers how to reliably farm the Twisted Heart of Uhkeiros and explains how to build around its HP-to-damage conversion to maximize its potential.

What is the Twisted Heart of Uhkeiros?

The Twisted Heart of Uhkeiros is a Unique Catalyst Relic with the following key effect:

Effect: Casting a spell consumes 5% of your current health and grants bonus damage based on the health consumed. Damage scales with missing health.

This means that every time you cast a spell, you sacrifice a portion of your current HP and gain increased spell damage or added damage depending on how much life was lost and how much HP you're missing.

The trade-off? Poor sustain or mismanagement can result in self-inflicted death—but for builds that can maintain life regeneration or leech, the Twisted Heart becomes a monstrous damage amplifier.

How to Farm the Twisted Heart of Uhkeiros

1. Understand Its Drop Source

The Twisted Heart of Uhkeiros is a boss-exclusive unique that drops from Uhkeiros, the Mountain Beneath—the final boss of the "The Black Sun" timeline in the Monolith of Fate system (specifically in empowered or regular versions of this timeline).

Timeline Name: The Black Sun

Boss: Uhkeiros, the Mountain Beneath

Level Requirement: Minimum timeline level 55 (Empowered: Level 100)

Drop Type: Exclusive boss drop (not target-farmable from normal loot pool)

2. Unlocking The Black Sun Timeline

To access Uhkeiros, you must complete a series of Monolith timelines leading up to The Black Sun. Ensure you’ve progressed far enough into the Endgame Monolith System:

Start with Fall of the Outcasts → Stolen Lance → The Black Sun.

Reach 100 Stability to unlock the Boss Arena for The Black Sun.

Defeat Uhkeiros to roll for a chance at the Twisted Heart drop.

3. Farming Strategy

Speed farm lower Empowered Timelines (100 level) to minimize difficulty while still gaining the best drop rates.

Increase Corruption to improve unique drop chances.

Use Blessings that boost drop rate of rare items or improve timeline rewards.

Consider using builds with strong AoE and single-target burst for quick boss clears.

Tip: While it’s a rare drop, the heart is not Legendary—meaning it can drop relatively early, though the chance increases with empowered corruption scaling.

Building Around Twisted Heart – HP-to-Damage Synergy

To unlock the full potential of the Twisted Heart, you need a build that embraces HP loss, sustain, and spell casting. Below are some of the best strategies to build around it.

Core Mechanics and Scaling

1. Life Sustain Is Mandatory

Since casting drains your current health, having high regeneration, leech, or health-on-hit mechanics is key. Consider:

Spell Leech: Gained from gear, passives, or affixes.

Health Regen: Useful for smoother health cycling between casts.

Ward Generation: Mitigates instant health loss and acts as a buffer.

2. High Maximum Health

The more health you have, the more raw damage you can extract. Use:

Increased Health Prefixes on chest, helm, and belt.

Vitality as a base stat to passively increase max HP.

Unique Items that scale with or multiply max HP.

3. Low-Cost Spells with High Cast Rate

To get consistent returns, you want frequent casts:

Lich’s Hungering Souls, Spirit Plague, or Death Seal work great.

Paladin’s Smite or Judgment with HP scaling nodes.

Warlock’s Chaos Bolts if stacking damage over time.

Best Classes & Archetypes

Lich – The HP Vampire

Why it works: Lich thrives in low health zones and already has excellent sustain tools like health drain, leech, and Death Seal.

Synergies: Pair Twisted Heart with Soul Feast and Reaper Form for consistent recovery and huge AoE damage scaling with missing HP.

Paladin – Divine Self-Sacrifice

Why it works: Paladin has access to healing through passives, Holy Aura, and Smite healing.

Synergies: Cast Smite with Echoes while sustaining through Healing Hands, converting HP loss into burst damage.

Warlock – Health as Fuel for Chaos

Why it works: Warlock passives support HP degeneration and high-cast-frequency DoTs like Chaos Bolts or Malignant Spirits.

Synergies: Twisted Heart naturally fits into Warlock's chaotic casting and life-manipulation kit.

Itemization & Gear Tips

Recommended Affixes:

% Increased Health

% Spell Damage or Damage Over Time

Spell Leech

Health Regen

Ward Per Second (on relic or helmet)

Unique Pairings:

Exsanguinous (Chest Armor): Constantly drains HP to trigger low-health effects, great synergy.

Last Steps of the Living (Boots): Boosts power when low on health.

Bleeding Heart (Amulet): Converts health loss into life leech.

Playstyle Tips

Manage your casting rhythm to avoid going too low without sustain.

Don’t spam spells blindly—time casts to when your health buffer (regen or leech) is active.

Use defensive mobility like Transplant, Shield Rush, or buy Last Epoch Gold Teleport to avoid incoming burst when you’re vulnerable.

Consider using Ward-generating skills or passives to offset sudden HP drops.

Final Thoughts

The Twisted Heart of Uhkeiros is not just a unique relic—it’s a game-changing build enabler that transforms your life pool into a raw damage resource. While farming it requires some dedication in the Monolith of Fate, the reward is a relic that brings a fresh, daring twist to spellcasting builds.

Whether you’re bleeding yourself for power as a Lich, healing through it all as a Paladin, or embracing entropy as a Warlock, the Twisted Heart offers immense damage potential to those who master its blood-fueled rhythm.

If you want help theorycrafting a specific build using Twisted Heart, let me know your class or skills—I’ll be happy to help!

Jul-08-2025 PST