The objective is, like many of Downpours's missions, a relatively straightforward fetch quest involving the collection of a deceased inmate's cardiac organ. The dead inmate has had his heart ripped out of his chest, and the player must descend into the sewer labyrinth, which can be accessed by using a ladder close to the corpse, in order to retrieve the heart so it can be returned to its owner. There are two possible locations of the heart, depending on the difficulty. On Easy, the heart can be found by using the forensic flashlight and following the tracks. However, on Normal and Hard, the user will have to take a different route; it can be quite difficult to find, so below is a list of steps to take in order to retrieve the heart:
- From the ladder, go straight towards the end of the path.
- Turn left and go through the gate.
- Turn right.
- Go past the intersection ahead.
- At the second intersection, turn right.
- Continue until reaching a gate; open it and obtain the heart.
After collecting the heart, a large number of Screamers and Weeping Bats will spawn. The player will have to navigate back out of the labyrinth and return the heart to its owner. The easiest way to do this is to simply run past the enemies, making use of Murphy's speed.
- Completing the sidequest unlocks the achievement/trophy "Telltale Heart". This name is a reference to a short horror story called "The Tell-Tale Heart" by Edgar Allan Poe. Similar to the story itself, while searching for the heart in the sewers, the beating will be heard all the way, accelerating as the player gets near, similar to the Speaker in Poe's story as his madness deepens.
- The prisoner's heart being ripped out of his chest may have been a reference to how Walter Sullivan removed the hearts of his first ten victims.
- The prisoner resembles Adam Shepherd from Silent Hill: Homecoming and slightly Joseph Schreiber from Silent Hill 4: The Room.
- The quest is called "Dead Man's Hand" rather than heart because it refers to the hand of cards dealt in the poker game the victim was likely playing before his demise.