The ST segment of an ECG signal is a feature that changes in the event of cardiac ischemia, a condition that is an early warning sign of myocardial infarction. Being able to monitor this feature in real time would be highly beneficial for preventing recurrent heart attacks. However, to be worn daily, such a monitoring device must be extremely miniaturized, down to the scale of a single integrated circuit. Currently, it is possible to integrate a heart rate detector, but, to our knowledge, no existing work presents a chip capable of detecting ST segment deviation. This is mainly because accurate ST segment measurement requires low-distortion signal processing, as specified in the International Electrotechnical Commission (IEC) standard. At the same time, the system is required to filter out baseline wander, whose frequency components may partially overlap with those of the ST segment. In this study, we relied on wavelet-based analysis and reconstruction to compare several wavelet types. We optimized their hyperparameters to minimize implementation complexity while satisfying the low-distortion constraints. We also propose an ASIC-oriented architecture and evaluate its post-layout performance in terms of area and power consumption. The post-layout results indicate that the Daubechies wavelet db3 offers the best trade-off among the evaluated configurations. It exhibits an area utilization of $1.18$ mm² and a post-layout power consumption of $4.89$ $\mathsf{\mu }$W, while preserving the ST segment in compliance with the IEC standard, thanks in particular to its effective baseline wandering filtering of $6.9$ dB. These results demonstrate the feasibility of embedding automatic ST segment extraction on-chip.