An implantable medical device includes a sensing module configured to receive a cardiac electrical signal via electrodes carried by a medical electrical lead coupled to the implantable medical device and a control module configured to detect a lead issue. The sensing module is configured to produce cardiac sensed event signals and spike detect signals. The control module is configured to determine event intervals defined by consecutive ones of the received cardiac sensed event signals and the received spike detect signals and identify one or more received spike detect signals as lead issue spikes based on at least one of the determined event intervals.