In the middle I would do lilies, the left would have a feather and music notes coming out of it and on the right I would have a butterfly sitting on top of it with two skulls looking at each other one on each wing

I like the idea of flowers or foliage growing out of the heart. Could be a good way to include the heart with other aspects of a tattoo, rather than a heart just by itself

22 Most Realistic Heart tattoo That I Have Ever Seen

The standard heart tattoo design began over the late Alfredia age, here it is 22 Most Realistic Heart tattoos.