Methods and process for detection of myocardial ischemia involve detection and analysis of changes in electrical conduction velocity within the heart to monitor changes in the condition of the cardiac muscle and indicate possible ischemia. Conduction velocity slows considerably when oxygen supply to the heart is reduced. Analysis of electrical conduction velocity can be used to verify the occurrence of myocardial ischemia in a more reliable manner. Changes in conduction velocity may be monitored based on conduction time between electrodes positioned in the left and right ventricles of the heart. The electrodes may be endocardial or epicardial electrodes. In general, the techniques may involve launching a stimulation waveform at one electrode and sensing a local cardiac depolarization at another electrode to assess conduction time.