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If player has a judgement card and uses it inside devil room the beggar will pay out in items you would get in a devil room.Going out of the room will remove the extra heart container, if any Temporary health boosts such as those from the XI Strength Tarot Card or Liberty Cap will not reduce the number of heart containers lost from a deal.If the very first level is an XL map (Basement XL or Cellar XL), the Devil Room may appear after beating the second boss.However, it can still be accessed with The Joker Tarot Card. The Devil Room will not appear after beating the very first level in any case ( The Basement 1 or Cellar 1).This makes it possible to get items that cost 2 heart containers for 1 heart container only. If The Dice is used in the room, the items being sold can be re-rolled into other items from the pool, but the cost of Heart Containers will not change.Doing a deal with the devil counts as damage for the purpose of "No Damage" achievements.
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However, they will prevent Isaac from dying if he has no Soul Hearts.
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Invincibility granting items such as Book Of Shadows will not make the items free of health costs, unless you are playing as ?, where items that grant invincibility will allow you to "steal" Devil Room items.This makes it possible to enter the level before unlocking It Lives! The Devil Room on The Womb 2 will always contain a trapdoor to Sheol instead of two items.Judas' Tongue sets the price of all Devil Room items to 1 heart container, but all soul heart deals will remain the same.Isaac dies if he has a single heart container and an Eternal heart then makes a deal costing more two or more hearts.Without any heart containers, the gameplay functions exactly like ?, making red hearts and red heart-related items useless until more heart containers are obtained, along with other special effects such as Whore Of Babylon always being active.If the player has Soul Hearts and buys an item for exactly as many red heart containers as they currently have, Isaac will keep his Soul Hearts.If the player only has Soul Hearts and have less than three Soul Hearts Isaac will die.If the player has Soul Hearts and buys an item for more red heart containers than they currently have, Isaac will lose all heart containers and Soul Hearts, and will die from a single hit until more Soul Hearts or heart containers are collected.In Rebirth Devil Rooms can be extremely game breaking as the player can remove all red heart containers in order to buff certain items such as the Whore of Babylon, The Polaroid and The Negative similar to how these items normally act for ?.This does not happen in Rebirth if the player has any soul, shadow or eternal hearts. If the player has no Soul Hearts and buys an item for exactly as many or more red heart containers than they currently have, Isaac will die.When playing as ? or any characters without any heart containers upon entering the room, all items will cost 3 Soul Hearts.
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You can still take damage if you have Soul Hearts, but all Soul Heart damage taken lowers the chance of the room appearing slightly.