When Heartmender dies, its persist ability triggers, returning it from your graveyard to the battlefield without a -1/-1 counter on it due to Melira.
Resolve the Shilgengar ability
Repeat.
This loop hinges on a clever interaction where Shilgengar, Sire of Famine sacrifices Heartmender for a Blood token, sending it to the graveyard to trigger persist. Thanks to Melira, Sylvok Outcast, the -1/-1 counter that would normally be placed on Heartmender is prevented entirely, allowing the persist trigger to bring it right back without restriction. This cycle can be repeated indefinitely to churn out an endless supply of Blood tokens and trigger any number of enters-the-battlefield, leaves-the-battlefield, or death effects.