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Health upgrades, and healing items like Ambrosia will not negate a no-hearts run.
There is a real chance you got unlucky and didn't notice a health pickup.
I know that's not helpful! I'll add it to the bug list for Jack to specifically look over, and see if he can sort it out. Maybe there is something fishy with that one that we're currently not seeing.
Hopefully with the latest update making hearts far more noticeable, this is notably less likely to happen
And if anything does go amiss, and your clearly should have earned the medal, please be sure to let us know :)
The only difficulty-related achievements are:
-Dead / Deader / Deadest / Deaderest Estate
-Gnome Jeff
-Abomination Mumba