- Randomness can be the key factor to surviving this challenge, as sometimes coins will actually give Soul hearts, black hearts, and crucially, gold hearts. This means that if you get lucky and come into a lot of coins, you have a chance of easily and quickly increasing your health (in addition to potentially getting gold hearts), and the gold heart synergy will spawn more coins, resulting in potentially more health, allowing you to take some damage with impunity.
- When dimes or nickels are picked up, they will act as 10 or 5 of the pickup they act as respectively, which can lead to gamebreaking results such as getting 5 gold hearts at once.
- It is possible to use a Swallowed Penny along with a sacrifice room and the frequency of Gold Hearts to generate infinite coins. This also will end up triggering many of the sacrifice room's effects, such as transporting Isaac to Dark Room. The challenge can still be completed by defeating The Bloat at the end of the Dark Room stage. This can be done as early as the first floor. This may or may not be a bug.
- Getting a zero recharge item (like Kamikaze!) and using it rapidly can result in a game-breaking run due to the fact that it triggers a random effect.
- The scrambled map allows all secret rooms to be found for free easily. The highlight of where you are on the map does not reflect your location but it will only show spots on the map which actually are rooms even if they have not been uncovered yet, including secret and super secret rooms.
- Be very wary when using cards, as they could randomly activate a Suicide King effect.
- Although items have changed their appearances, the item Isaac gets still belongs to its item pool. Thus, it could be treated as Curse of the Blind as usual.
- Counterfeit Penny has a chance to grant coins upon picking them up, making it easier to accumulate coins.
- This challenge's effect of changing item appearance is similiar to the April Fool's 2016 daily challenge.
- The person who suggested this challenge got banned from /r/FUCKBLOAT, the anti-bloat subreddit, and had to use the "I love The Bloat" flair for a week on /r/bindingofisaac subreddit.