In this game, the player controls a doctor protecting a yellow micro-organism by stabbing viruses with forks. They use ✚ to shoot the viruses from one of four directions, depending on their placement on the map. If even a single virus gets to the end, the organism will pop.
The game is an endless version of the original, ending once a single virus gets through to the end without being stabbed. The game gets faster as it progresses, and new variations of viruses are introduced. Pink viruses take two hits, and black virus take three hits. Each time a virus is hit, the yellow organism releases a variety of objects, with a larger quantity and variety of objects as the game goes on.
Trials
The player has the option to select which difficulty they want in Rhythm Heaven Megamix.
Saffron Trial: Only blue viruses are in this version. There are 3 organisms.
Saltwater Trial: The blue viruses may skip a section. Pink viruses are added. There are 2 organisms.
Paprika Trial: The blue viruses may skip 1-3 sections. Pink viruses may skip 1-2 sections. Black viruses are added. There are 2 organisms.
This game is uniquely set up like a tower defense game.
While stabbing a virus, followed by an off-beat virus, a star appears next to the doctor as he blushes.
Although only blue viruses appear in the normal version of the game, a black virus appears in Remix 7.
The music used in the Endless Game in Rhythm Tengoku is a slightly remixed version of the normal music. In Rhythm Heaven Megamix, the music is an arrangement in the same style as the original, except for the addition of an ending note in the Gatekeeper Trio's Trials.
This is the only Endless Game in Rhythm Heaven Megamix whose Trial goal isn't to reach a certain score, but rather to reach the end. The trials last two loops of the game's music, just as long as the Rhythm Game from Rhythm Tengoku. However, the arrangement of the viruses doesn't match it in any of the trials.