Electrocardiographic signs of pulmonary hypertension in children who snore.

Two children presented with sleep disturbances due to enlarged tonsils and adenoids. One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium. As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both. During a nine-month period an electrocardiogram was taken in 92 children. Three electrocardiograms (3.3%) showed evidence of right heart strain. The children with abnormal electrocardiograms had symptoms of sleep disturbance with apnoea, snoring, and daytime somnolence. These symptoms and the electrocardiographic changes were reserved by adenotonsillectomy. The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated. When signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery in view of the potentially fatal consequences.