Sheer Heart Attack takes the form of a plated sphere with a superficial, removable knob on its top and tank treads on either side. Later, the space behind its stomach is revealed to be hollow and suitable for storing an object. In the anime, after receiving the third bomb, Killer Queen's eyes adopt a deep glow. Its shoulders, the back of its hands, belt buckle, a plate hanging in front of its crotch, both sides of its ankles and the top of its feet all bear the emblem of a skull with ears resembling its own, in varying sizes and external decoration. Four short spikes line the top of its back. On its index finger's middle phalanx, there is a small red button similar to those found on stereotypical detonators. Its thumbs are additionally bandaged in white. It wears dark, studded, leather-like forearm-length gloves, mirrored in style by a garter belt-like band at its waist and ankle-height footwear. It has no nose, and its thin-lipped mouth is perpetually closed. Its eyes comprise cat-like vertical pupils in front of its generally light-colored sclera.

Its crown is flat, while two sharp, triangular shapes resembling cat ears stand on both sides of the top of its head. In both the manga and anime, it is portrayed as light pink, while in the All Star Battle video game, it is portrayed as white. Killer Queen is a visibly muscular humanoid Stand about as tall as Kira himself, light in color overall.

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