A device and method of detecting the severity of myocardial ischemia and heart attack risk is provided. The method includes obtaining an electrogram signal, determining T-wave measurements based on the electrogram signal, and determining ST segment measurements based on the electrogram signal. The method also includes identifying T-wave alternans based on the T-wave measurements and identifying ST segment changes based on the ST segment measurements. The method further includes correlating the T-wave alternans with the ST segment changes in order to detect a severity of ischemia.