Electrocardiography (ECG) records the electrical activity of the heart, aiding diagnosis by detecting abnormalities in cardiac function. ECG foundation models have demonstrated promising results, but are limited by a reliance on ECG interpretation reports as their sole supervision. Because interpretation reports only capture the subset of waveform information routinely recognized by clinicians, this constrains representation learning to overlook the broader diagnostic signals present in ECG. We introduce a new ECG foundation model --- MS-ECG-FM --- that is trained through contrastive alignment to multiple distinct clinical note types, including ECG, echocardiography, radiology, and discharge reports. We evaluate MS-ECG-FM on an extended set of ECG detection benchmarks, showing that it comprehensively outperforms existing methods on the full span of conditions that ECG can detect, including in reduced-lead configurations. Different reports improve representations for different diagnostic domains, while multi-source alignment captures their complementary information and produces consistently strong representations across clinically diverse tasks.

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