Case Presentation A 38-year-old female, gravida 2 para 1, at 24 weeks of gestation, presented with a chief complaint of progressive shortness of breath for one week, with worsening orthopnea over the preceding two days. History of Present Illness Dyspnea initially mild, progressively worsening Significant limitation in daily activities Inability to lie flat due to breathlessness No chest pain, palpitations, syncope, fever, hemoptysis, or cough Obstetric History One prior full-term vaginal delivery without complications Current pregnancy previously uncomplicated Normal first- and second-trimester prenatal evaluations Physical Examination General : Acute respiratory distress, tachypneic, sitting upright Vital Signs: Blood pressure: 170/110 mmHg Heart rate: 102 beats/min Respiratory rate: 28 breaths/min Oxygen saturation: 88% on room air Temperature: 36.8°C  Cardiovascular : Elevated…