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A new electrocardiogram (ECG) monitor with automated ST analysis and display capability has been developed to assist healthcare professionals identify the site and severity of acute ischemic changes. The monitor displays the changes as a 3D image of the heart in real time. The underpinning assumption is that images are easier to interpret than ECG traces. We describe here the features of two functions of the monitor, the ischemia detection and imaging function (IF). The ischemia detection function was validated using the European ST-T database, and was found to have a sensitivity of 85% and positive predictivity of 93%. Fifty doctors took part in the evaluation of the new IF and the results showed an increase in their median proficiency to diagnose ischemia from 50% to 100% and an increase in their certainty of the diagnosis from 65% to 80%. The time to reach a diagnosis for eight ECGs, dropped from 15 to 9 min.