Techniques are described for detecting changes in posture detecting cardiac ischemia while accounting for changes in posture and delivering therapy or warning signals in response thereto using the implantable medical device. In one example, the device detects variations in the electrical cardiac signals indicative of a possible episode of cardiac ischemia. Changes in patient posture are detected as well using an accelerometer or similar device. Then, an episode of cardiac ischemia is detected based on the variations in the cardiac signals while distinguishing variations due to changes in posture. In another example, the device instead detects changes in posture based on transient changes in morphological features of electrical cardiac signals.
