A 37-year-old female is four days postpartum and reports she can't catch her breath when lying flat but not when seated. What should you suspect?

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Postpartum hypercoagulability raises the risk of clot formation, making pulmonary embolism a top concern when a woman four days postpartum has new shortness of breath that worsens when lying down. In this window, an embolus traveling to the lungs can cause acute dyspnea even in the absence of classic chest pain, and the recumbent position can worsen symptoms due to changes in venous return and pulmonary circulation. Among the choices, a pulmonary embolism fits the postpartum risk profile and the presentation of breathlessness, whereas pneumothorax (sudden chest pain and unilateral breath sounds), myocardial infarction (chest pressure with possible sweating and nausea), and an asthma attack (wheezing, history of asthma) are less consistent with this scenario. In practice, treat with high suspicion for PE, provide oxygen as needed, and arrange urgent evaluation and transport.