When Simamkele Selem was diagnosed with pulmonary embolism in January 2024, at the age of 21, she knew nothing about the condition.
What followed was something that she never expected. She needed assistance with daily tasks because of muscle weakness caused by long-term hospitalisation and oxygen use. There were multiple follow-up appointments with cardiologists, a series of tests, a heart attack, surgery and physiotherapy for recovery. Selem was also exhausted from having to travel from East London to Cape Town for treatment.
Today, Selem is raising awareness about the life-threatening condition.
“Coming from a small town called Alice in the Eastern Cape, living in a hidden village called Jonini Location, I initially thought pulmonary embolism was a condition that only affected people overseas. But my diagnosis changed that perspective. This condition poses significant risks, particularly for elderly individuals, but also for younger people like myself,” she says.
“As someone who was previously obese, I believed that factors like obesity, lack of exercise, and unhealthy eating habits contributed to pulmonary embolism. However, it’s essential to understand that various factors increase the risk of developing this condition.”
Health-e News spoke to Dr Raisa Bhikoo, a pulmonologist and specialist physician practising at Netcare N1 City Hospital in Cape Town, who explains what pulmonary embolism is.
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What is pulmonary embolism?
Pulmonary embolism (PE) is a blockage in one of the arteries in the lungs, usually caused by a blood clot that travels from the deep veins of the legs (deep vein thrombosis or DVT) to the lungs. This blockage prevents normal blood flow and reduces oxygen levels in the body, which can strain the heart and be life-threatening if not treated promptly.
What are some common causes and risk factors?
The most common cause of pulmonary embolism is a blood clot that originates in the deep veins of the legs or pelvis. Risk factors include prolonged immobility (such as during long flights or bed rest), surgery (especially orthopaedic or abdominal), trauma, cancer, pregnancy, use of hormone therapy or contraceptives, obesity, smoking, and certain genetic clotting disorders.
What are the symptoms?
Symptoms of pulmonary embolism can include sudden shortness of breath, sharp chest pain (worsening when breathing deeply), rapid heartbeat, coughing (sometimes with blood), dizziness, or fainting. These symptoms can be similar to other conditions like heart attack, pneumonia, or anxiety attacks. However, in PE, symptoms often appear suddenly, and shortness of breath is typically disproportionate to any exertion.
How prevalent is it in South Africa?
In South Africa, pulmonary embolism is a significant but often underdiagnosed condition. The true prevalence is difficult to establish due to limited national statistics, but studies suggest it contributes notably to cardiovascular-related hospital admissions.
Diagnosis can be challenging because symptoms mimic other conditions, such as pneumonia or a heart attack. Common diagnostic tools include CT pulmonary angiography, D-dimer blood tests, and ultrasound of the legs.
Are there ways to prevent pulmonary embolism?
Preventive measures include staying active and avoiding long periods of immobility,
maintaining a healthy weight, quitting smoking, staying hydrated, and using compression
stockings during travel or post-surgery. In high-risk individuals, doctors may prescribe blood-thinning medication (anticoagulants) as a preventive measure.
Who are high-risk individuals?
Individuals at higher risk of pulmonary embolism include:
- the elderly,
- people with a history of blood clots,
- those who are bedridden or have prolonged immobility,
- patients with cancer,
- women who are pregnant or postpartum,
- individuals on hormone therapy, and
- people with inherited clotting disorders.
How is PE treated?
Treatment typically involves anticoagulant (blood-thinning) medication to prevent further clotting and allow the body to gradually dissolve the clot. In severe cases, clot-dissolving drugs (thrombolytics) or surgical removal of the clot may be required.
In South Africa, treatment is generally available in both public and private healthcare settings, though access to advanced imaging and thrombolytic therapy can be more limited in rural areas.
