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How I like to build Hecarim:
Start with boots 1, ruby and longsword
Finish into Mercs and Phage
Next get a Brutalizer
Then get your Sheen
Finish up Trinity
Next Chain Vest into Atmas
Finish up Ghostblade
Hexdrinker - Maw
So to lay it out
Also, if you want to duel or have 1v1 potential, heres what you do.
Don't start off with E, this is a common mistake (or Ult). If you are dueling, chances are the enemy champ isn't running from you and thinks they can take you.
Let them blow early CDs/get you to around 50-60% health. All you want to do in this time is spam Q, and try to get your 2 stacks up and deal some intial damage through Q/Sheen procs.
When they get you to about 50-60%, you then go for the kill combo. This is W/Ult/E/Q/Sheen proc. Remember, W heals you based on (depending on rank), up to 30% of the damage done in those 4 seconds. Guess what, if you save your burst for those 4 seconds, you maximize your self healing. It also stands to reason that the you moving like a crazy person-fear-knockback prevents them from doing much damage at all to you in this 4 second window whilst you heal yourself.
So what happens is that, you heal yourself for a ton (if you are at 50% this should put you easily at 70% plus as long as you aren't trying to beat on a full tank), you CC lock your enemy for about 3 seconds, and you deal some decent burst damage.
Now ofc it depends where in the game/build you are at, but lets say its later game and you have a very reasonable (with ad runes and his passive) 200 AD (which with the build I posted, is on the low side).
Before mitigation (ofc), you are looking at
E: (depends but about 300)
Sheen procced auto: 400 (if no crit)- 650 (if crit).
So you are looking at between 1750-2000 damage (before resists/armor are factored), in this 4 second burst window, and thus between 525-600 self healing from your W.
Even if you are only pulling 1400 after mitigation is factored, thats still 420 healing.
So assuming your opponent has roughly 3k life (and isn't an uber tank). This strategy will likely take them down around 50%-60% in this 4 second window, and heal you for 15-20% of your hp. If they are a glass cannon or carry or something, you could potentially be looking at more like 70% of their hp and 25% of your hp back.