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These grant access to the Chest and Dark Room repectively. There is no requirment to beat the game on hard mode to access these areas.
Yes, just play on the default difficulty as whoever you wish and have fun learning the game as you work towards unlocking more content.
If you want to get to the new content right away and don't care about the experience, Azazel is a very powerful character that will allow you to have the easiest time beating the base content (make three devil deals in one run to unlock him. You increase your chances of getting devil rooms by beating floors without taking red heart damage). Or you can constantly restart runs (by holding the R key) until you start with an item room next to you with a good item in it.
The system works well. You've got an acheivable victory goal in killing mom's heart and by the time you unlock the final chapters, you'll be less reliant on getting lucky with the items you find and will be ready for the challenges ahead.
By now you should have unlocked a couple more characters to play as. Like Isaac, they have item unlocks for reaching certain milestones with those characters, so you can be working on those at the same time as working through your remaining Mom's Heart Kills.
Overall, just keep playing the game in whatever way brings you the most enjoyment. You've got so much still to discover that you don't need to be so focused on reaching the ending.
Aka Isaac