The Malignant Heart is a vital component in Diablo 4, crucial for challenging the Echo of Varshan in Season 2. As one of the four Malignant Body Parts required, understanding how to obtain, farm, and use the Malignant Heart is key for progressing. 

Whisper Caches and Grotesque Debtors

The Malignant Heart can be obtained through Whisper Caches, which are earned by collecting a minimum of 10 Grim Favors and returning to the Tree of Whispers. Completing the Whispers of the Dead quest grants a cache with a chance to drop Varshan summoning parts, including the Malignant Heart.

Participating in Blood Harvest events offers another consistent method. Navigate the blue zones on the Sanctuary map and look out for Grotesque Debtor enemies, identifiable by warnings and a Malignant Heart symbol on the mini-map. Defeating them also provides a chance to obtain one of the four Varshan summoning parts.

Body Part Drops

When opening caches or defeating a Grotesque Debtor, any of the four body parts may drop: Malignant Hearts, Blackened Femurs, Gurgling Heads, or Trembling Hands. All four are necessary for summoning the Uber version of Nightmare Echo of Varshan in World Tier 4. However, in World Tier 3, you may proceed without the heart.

World Tier 4 Requirements

To summon the Echo of Varshan in Torment difficulty, players are required to place at least one of each body part in the Malignant Altar of the Malignant Burrow. Access the lair by navigating to the Tree of Whispers and examining the ground to the left, preparing yourself for the imminent boss fight with Varshan.

Obtaining Malignant Hearts through Whispers of the Dead Caches

Cache Rewards

Similar to other Malignant Body Parts, the Malignant Heart can be obtained by completing the Whispers of the Dead quest and opening the cache reward. However, it is crucial to note that the Malignant Heart is exclusively available in World Tier 4.

Locating and Defeating the Grotesque Debtor

Guaranteed Drops

Killing a Grotesque Debtor guarantees a random Malignant Body Part. Focus on areas with Grim Favor rewards and Blood Harvest Events to maximize your chances, allowing you to simultaneously grind for this Elite enemy while completing the Whispers of the Dead quest.

Stash Transfers:

Missed Malignant Body Part drops are automatically transferred to your stash. Ensure you regularly check the Missed Equipment tab to recover any lost items.

Utilizing the Malignant Heart

Summoning the Echo of Varshan

Malignant Body Parts are utilized to summon the Echo of Varshan inside the Malignant Burrow, located beside the Tree of Whispers in the Hawezar region’s Writhing Mire. The Malignant Heart becomes a necessity when engaging in World Tier 4.

Crafting Material

Given its rarity, the Malignant Heart can also be used as a crafting material. Speak to the Alchemist to craft any of the other three Malignant Body Parts using the Malignant Heart.