I used to run a DX2/66 with no HSF, and a DX4/100 overdrive w/ the stock passive cooling.
The 66 had no issues, stable while running Hexen, used to run pretty much 24/7.
They get damn hot, for sure, but I believe that's an advantage of the ceramic packaging - they dont seem to mind it too much.
But in any case, a 486 heatsink cant be worth much more than 10c 😉
Got an old video card with a heatsink on it? That'll do the job...