Fatal Hearts is an adventure/visual novel video game in which players control a teenage female protagonist who is having strange dreams while people are being murdered. Like traditional adventure games, the player must solve puzzles and minigames to progress through the story, but like visual novels, the player must choose the path that the story goes down in order to reach up to 14 different endings.

Because some of the endings include romances with male characters, it counts as a romance game. The game uses anime-style graphics but is written in English.