Heart failure missed by ECG is not a rare exception — it is a systemic problem that continues to delay diagnosis, even when warning signs are present.
A story from the European Society of Cardiology Congress, Madrid 2025
At the European Society of Cardiology Congress in Madrid (August 29 – September 1, 2025), our booth was busy with demonstrations of the Cardio-HART system.
Like most congress demonstrations, no real patients were being examined — only simulated tests to showcase the technology.
But sometimes real life intervenes.
A chance encounter
One of the venue’s security guards, an older gentleman stationed nearby, had been quietly observing the demonstrations. He was polite, professional, and took pride in guiding visitors through the hall. After watching a group from China complete a demo, he approached us hesitantly and asked a simple question:
“Could you test me too?”
As he stepped closer, the nurse assisting immediately noticed what he was trying to conceal — shortness of breath, pallor, and the fatigue of someone working through symptoms. When asked, he explained that earlier that summer he had visited his GP for breathlessness and palpitations. An ECG had confirmed atrial fibrillation. Medication was prescribed, and an echocardiogram was requested — as a routine referral.
The first available appointment: February 2026.
Eight months away.
A test on the floor
We agreed to test him. There was no examination table available, so he lay down on the floor beside the booth. Standard ECG electrodes were applied, along with one additional Cardio-HART sensor.
The procedure was identical to an ECG.
The difference was in what it could see.
Cardio-HART records three one-minute sessions, combining electrical, acoustic, and mechanical cardiac bio-signals. From these, it generates structural and functional findings typically associated with echocardiography — without imaging, without a specialist, and with results available within minutes.
We expected to simply confirm atrial fibrillation.
When the report arrived
Less than two minutes later, the report appeared.
At that exact moment, two cardiologists happened to stop at the booth — one from the UK, a senior ESC committee member, and one from Germany, a recognised heart failure specialist who had just spoken in the main auditorium.
They leaned in.
“Is this real?” the German cardiologist asked quietly.
“Yes,” the British cardiologist replied. “I use this device in my clinic. I’ve learned not to ignore what it shows.”
She pointed to the report.
“The ECG confirms AFib — nothing surprising. But look here. These are echo-equivalent findings. Severe structural and functional dysfunction. There’s even evidence consistent with a recent mild myocardial infarction.”
She looked at the patient.
“This man needs an echocardiogram now. Not in eight months.”
What ECG could not see
On the ECG side of the report, there was little urgency: atrial fibrillation, an indeterminate PR interval, otherwise unremarkable findings.
On the echo-equivalent side, the picture was very different — widespread abnormalities, reduced ejection fraction, and signs consistent with advanced heart failure.
This is not unusual.
In roughly one out of four patients, ECG alone appears reassuring while structural disease progresses silently — visible only when imaging, or equivalent diagnostics, are applied.
“I have to pay the rent”
The cardiologists advised him firmly: go to the emergency department immediately. Do not drive yourself. Call an ambulance if needed.
The man shook his head.
Leaving work would mean losing that day’s pay — and the overtime he relied on to cover rent. Quietly, almost apologetically, he said the words that define healthcare inequity everywhere:
“I have to pay the rent.”
After discussion, his daughter agreed to collect him the next morning and take him to hospital.
The system closes its eyes
At the emergency department, he presented the Cardio-HART report.
It was dismissed.
“This doesn’t mean anything to us.”
Standard protocol followed: another ECG. Again, atrial fibrillation. Nothing more. Medication was adjusted, and he was sent home. No echocardiogram. No escalation. No urgency. Not even a natriuretic peptide test.
The report that had alarmed two cardiologists — highlighting structural failure invisible to ECG — was ignored because it did not fit the pathway.
A private echocardiogram was unaffordable. Its cost exceeded several days’ wages.
A quiet tragedy
When the cardiologists later learned what had happened, they were deeply disturbed. Ignoring those findings, they said, amounted to leaving a progressive disease untreated — a condition that will erode quality of life and carries a real risk of sudden decompensation.
This man — a future grandfather, a diligent worker who helped keep Europe’s largest cardiology congress safe — may suffer far more than he should have.
Not because medicine lacked the tools.
But because the system refused to use them.
Lessons from Madrid
This true story captures several uncomfortable truths in modern cardiology:
- Early disease often hides behind “normal” ECGs
- Routine referrals can mask urgent pathology
- Validated innovation is still rejected by rigid pathways
- Economic vulnerability limits patient choice
- The failure is systemic — not clinical
The tragedy is not that technology exists.
The tragedy is that, too often, it is seen — and then ignored.
Sometimes the greatest danger is not what medicine cannot detect, but what the system chooses not to see.
