A ventricular assist device incorporating a rotary pump configured to be in fluid communication with a heart and systemic circulation of a subject to assist blood flow from the heart to the systemic circulation. The device includes a pump drive circuit for applying power to the pump, one or more sensors for sensing one or more electrogram signals (such as subcutaneous pre-cordial electrode signals) in the patient, and a signal processing circuit to determine the presence or absence of a reduction in cardiac blood flow, ischemic condition or myocardial infarction condition based on subcutaneous pre-cordial electrode signals, to control power supplied to the pump from the pump drive circuit, and to operate the pump in either a normal sinus rhythm mode in the absence of an ischemic condition or myocardial infarction condition, or a modified mode of operation in the presence of an ischemic condition or myocardial infarction condition.
