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Please note: A lot of things cause tingling in the face + extremities ("neuropathy") as well as lightheadedness, but in this question, I'm only interested in potential heart conditions, or anything cardiovascular in etiology.

Is it possible for someone to have an underlying heart/vascular condition that is causing neuropathy and lightheadedness, but to also have a perfectly "clean" ECG? If so, what condition(s) exist and why do they fly under the "ECG radar"?

I googled this extensively and either nothing came back, or the results mentioned that ECGs would be successful in detection.

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  • You say neuropathy but do you really just mean tingling in the extremities? Neuropathy literally means damage to or a disease of the nerves.
    – Carey Gregory ♦
    Jan 27, 2016 at 0:08

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A temporary arrhythmia could cause episodes of lightheadedness etc. You would only see that on an ECG if you were recording it right there and then when it happened. If the patient went to see a Dr. afterwards nothing would show up on the ECG.

As highlighted by Carey Gregory this is missing some evidence. Thanks for pointing out the rules here. Here a link to a study looking at Transient Cerebral Ischemia Due to Arrhythmia which would explain the symptoms you asked for (dizzyness/tingling). The majority of the symptomatic patients had an episode of Supra Ventricular Tachycardia.

This paper is about the use of a patient activated ECG vs. 24hr ECG recording. The idea is to catch the event in the act as there will be no evidence left once it is over in most cases anyway.

Here a nice paper with case studies about occult arrhythmia causing falls in the elderly.

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