An acute ischemia monitor is disclosed. The monitor, which includes an analog to digital convertor and a processor that performs beat detection, monitors the time course of a heart signal parameter, namely ST segment deviation, computed from an electrocardiogram. The device stores ST deviation statistics for multiple leads. For each lead, upper and lower ST deviation boundaries are computed. For each lead, current ST deviation values are compared with the statistical values to determine a metric indicative of the degree of abnormality of a current ST deviation value. The metric is equal to the difference between the current ST deviation value and the upper or lower boundary, normalized according to the dispersion of the ST deviation. Metrics from different leads are summed and compared to a threshold to determine whether the combined metric is indicative of a cardiac event.