A red heart with a small fire on the top, and a cross on the front of it in a brighter shade of red.
- Isaac's eyes glow white as glowing tears stream down his face.
- Shots are larger and home in on enemies.
- Damage is multiplied by 2.3 then +1. Increases Range by 4.125. Decreases Tears by 0.4, and decreases Shot Speed by 25%.
- Gives 1 Soul Heart upon pickup.
- Restores all Red Hearts upon pickup.
- All bombs also home in on enemies, including those created by Dr. Fetus.
- Technology - Turns laser purple (similar to Spoon Bender) and increases damage.
- The Parasite - Split tears will also home in on enemies, greatly increasing damage output.
- IPECAC - Slows down the shot, and allows them to home on enemies.
- Dr. Fetus: - Bomb turns white and home in on enemies.
- Odd Mushroom (Thin) - Increases fire rate of tears greatly, allowing to fire a wall of homing tears and to deal incredible amounts of damage. The slight damage down also takes effect on Sacred Heart tears.
- Mutant Spider - Effects are stacked.
- Cupid's Arrow - Creates piercing homing shots that pass through the enemy, then home in on the next.
- Lump Of Coal - The slower shot speed means a slight damage boost.
- Polyphemus - Makes homing tears about the size of Issac's head and turns them white, massively increasing damage.
- The item is based upon the Most Sacred Heart of Jesus, a Catholic devotion which uses the image of Christ's physical heart (often depicted as glowing, burning, and crowned with thorns) as a symbolic representation of His infinite and long-suffering love for humanity.
When the sacred tears go through the Lemon Mishap, tears will stay in the middle of the lemon juice but not dropping down.