ECG (Electrocardiogram) - Complete Notes for 3rd Year Medical Students

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ── Palette ────────────────────────────────────────────────────────────────
// Deep navy dominant, crimson accent, white / light-steel secondary
const C = {
  navy:       "0D1B2A",   // dominant bg
  navyMid:    "1A2E45",   // card bg
  navyLight:  "1E3A5F",   // lighter card / stripe
  crimson:    "C0392B",   // accent red (ECG trace colour)
  crimsonSoft:"E74C3C",   // lighter accent
  teal:       "1ABC9C",   // positive highlight
  amber:      "F39C12",   // warning / caution
  white:      "FFFFFF",
  offWhite:   "EDF2F7",
  steelGray:  "8FA8C8",   // muted text
  lightGray:  "BDC3C7",
};

// ── Helper utilities ───────────────────────────────────────────────────────
function fetchImages(...urls) {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`
  ).toString();
  return JSON.parse(result);
}

// Download key ECG images used throughout the deck
const imgUrls = [
  "https://cdn.orris.care/cdss_images/ef815eeb06c673b405e3c7f9112d1e9ff6fbea96a00a2723b233d384156386bd.png", // ECG waveform diagram
  "https://cdn.orris.care/cdss_images/ed3e36266afd563652d7495682c022c3508452257126640a6ab3375b0b0a7e46.png", // Conduction system
  "https://cdn.orris.care/cdss_images/a768a511d3107d6bff69c3e8cf7b50c4485d458be34be6234f7fc6d4ca4fc3ec.png", // Cardiac cycle
];
console.log("Downloading images...");
const imgs = fetchImages(...imgUrls);
const ecgWaveImg  = imgs[0].base64;  // waveform
const condSysImg  = imgs[1].base64;  // conduction system
const cardCycImg  = imgs[2].base64;  // cardiac cycle

// ── Presentation setup ─────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout  = "LAYOUT_16x9";
pres.title   = "ECG Interpretation – A Systematic Approach";
pres.author  = "Medical Education";
pres.subject = "Electrocardiography";

// ── Slide helpers ──────────────────────────────────────────────────────────

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// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 1 – Title
// ══════════════════════════════════════════════════════════════════════════
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    { text: "For 3rd Year Medical Students\n", options: { breakLine: true } },
    { text: "Based on Goldman-Cecil Medicine & Medical Physiology" }
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// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 2 – Why ECG & What It Measures
// ══════════════════════════════════════════════════════════════════════════
{
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  addHeaderBar(s, "What Does the ECG Measure?", "Understanding the fundamentals before systematic interpretation");

  // Conduction system image
  s.addImage({ data: condSysImg, x: 5.6, y: 1.2, w: 4.1, h: 3.5 });

  const items = [
    ["Heart Rate",    "Beats per minute from R-R interval"],
    ["Rhythm",        "Origin & regularity of the pacemaker"],
    ["Axis",          "Net direction of ventricular depolarisation"],
    ["Intervals",     "Conduction time through each structure"],
    ["Morphology",    "Hypertrophy, ischaemia, infarction patterns"],
  ];
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}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 3 – ECG Paper & Calibration
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "ECG Paper & Calibration", "Know your grid before measuring anything");

  // Waveform image right
  s.addImage({ data: ecgWaveImg, x: 5.2, y: 1.2, w: 4.5, h: 3.9 });

  // Two info cards
  const gridData = [
    ["Small Box (1 mm)", "0.04 sec  |  0.1 mV"],
    ["Large Box (5 mm)", "0.20 sec  |  0.5 mV"],
    ["Standard Speed",   "25 mm / second"],
    ["Calibration",      "10 mm = 1 mV"],
    ["Recording Time",   "10 seconds (standard)"],
  ];
  gridData.forEach(([label, val], i) => {
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    s.addText(label, {
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  s.addText("Normal ECG Waveform with Intervals\n(Goldman-Cecil Medicine)", {
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}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 4 – The 12 Leads
// ══════════════════════════════════════════════════════════════════════════
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  s.background = { color: C.navy };
  addHeaderBar(s, "The 12 Leads – What Each Views", "Each lead is a different vantage point on the same electrical activity");

  const limb = [
    ["I",    "Left arm (+)",    "Lateral"],
    ["II",   "Left leg (+)",    "Inferior"],
    ["III",  "Left leg (+)",    "Inferior"],
    ["aVR",  "Right arm (+)",   "Cavity (inverted)"],
    ["aVL",  "Left arm (+)",    "Lateral"],
    ["aVF",  "Left leg (+)",    "Inferior"],
  ];
  const prec = [
    ["V1", "4th ICS R sternal border", "Septal / RV"],
    ["V2", "4th ICS L sternal border", "Septal"],
    ["V3", "Between V2 & V4",          "Anterior"],
    ["V4", "5th ICS midclavicular",    "Anterior"],
    ["V5", "Anterior axillary line",   "Lateral"],
    ["V6", "Midaxillary line",         "Lateral"],
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     { text: "Positive Electrode", options: { bold: true, color: C.white } },
     { text: "Territory", options: { bold: true, color: C.white } }],
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     { text: "Position", options: { bold: true, color: C.white } },
     { text: "Territory", options: { bold: true, color: C.white } }],
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  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 5 – The Normal Waveforms
// ══════════════════════════════════════════════════════════════════════════
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  s.background = { color: C.navy };
  addHeaderBar(s, "The Normal ECG Waveforms", "What each deflection represents physiologically");

  const waves = [
    { name: "P Wave",      color: C.teal,       text: "Atrial depolarisation  |  < 120 msec  |  < 2.5 mm limb leads" },
    { name: "PR Interval", color: C.steelGray,  text: "Atrial dep. → ventricular dep. (AV node delay)  |  90–200 msec" },
    { name: "QRS Complex", color: C.crimsonSoft,text: "Ventricular depolarisation  |  75–110 msec" },
    { name: "ST Segment",  color: C.amber,      text: "Early ventricular repolarisation (plateau)  |  Isoelectric = normal" },
    { name: "T Wave",      color: C.teal,       text: "Ventricular repolarisation  |  Upright I, II, V3–V6" },
    { name: "QT Interval", color: C.crimsonSoft,text: "Total ventricular activity  |  QTc = QT / √RR  |  ♂ ≤450 ms  ♀ ≤460 ms" },
    { name: "U Wave",      color: C.steelGray,  text: "Purkinje repolarisation (debated)  |  Prominent → hypokalemia" },
  ];

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    const row = i < 4 ? i : i - 4;
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    const y = 1.22 + row * 0.88;
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    addAccentStripe(s, x, y, 0.74, w.color);
    s.addText(w.name, {
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  // ECG image at bottom right of col 2 (fills remaining space)
  s.addImage({ data: ecgWaveImg, x: 5.1, y: 4.46, w: 4.6, h: 1.05, transparency: 20 });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 6 – Normal Intervals Table
// ══════════════════════════════════════════════════════════════════════════
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  addHeaderBar(s, "Normal Interval Reference Table", "Memorise these — they define normal vs. abnormal");

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     { text: "Normal Range",   options: { bold: true, color: C.white, fill: { color: C.crimson } } },
     { text: "If Abnormal…",   options: { bold: true, color: C.white, fill: { color: C.crimson } } }],
    [{ text: "Heart Rate",         options: { color: C.teal, bold: true } },
     { text: "50–100 bpm",         options: { color: C.offWhite } },
     { text: "Brady / Tachycardia", options: { color: C.steelGray } }],
    [{ text: "P Wave Duration",    options: { color: C.teal, bold: true } },
     { text: "< 120 msec",          options: { color: C.offWhite } },
     { text: "Atrial enlargement",  options: { color: C.steelGray } }],
    [{ text: "PR Interval",        options: { color: C.teal, bold: true } },
     { text: "90–200 msec",         options: { color: C.offWhite } },
     { text: "AV block (↑) / WPW (↓)", options: { color: C.steelGray } }],
    [{ text: "QRS Duration",       options: { color: C.teal, bold: true } },
     { text: "75–110 msec",         options: { color: C.offWhite } },
     { text: "Bundle branch block > 120 msec", options: { color: C.steelGray } }],
    [{ text: "QTc  (Male)",        options: { color: C.amber, bold: true } },
     { text: "390–450 msec",        options: { color: C.offWhite } },
     { text: "TdP risk if prolonged", options: { color: C.steelGray } }],
    [{ text: "QTc  (Female)",      options: { color: C.amber, bold: true } },
     { text: "390–460 msec",        options: { color: C.offWhite } },
     { text: "TdP risk if prolonged", options: { color: C.steelGray } }],
    [{ text: "QRS Axis",           options: { color: C.teal, bold: true } },
     { text: "−30° to +90°",        options: { color: C.offWhite } },
     { text: "LAD / RAD",           options: { color: C.steelGray } }],
  ];

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    x: 0.4, y: 1.25, w: 9.2, h: 3.95,
    border: { pt: 0.5, color: C.navyLight },
    fill: { color: C.navyMid },
    colW: [2.6, 2.8, 3.8],
    fontSize: 12.5,
    rowH: 0.46,
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  s.addText("Bazett's Formula:  QTc = QT (sec) ÷ √RR (sec)   |   Measure QT in leads II, V5, V6 – use the longest", {
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    fontSize: 11, color: C.amber, italic: true, bold: true, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 7 – Step-by-Step Interpretation Framework
// ══════════════════════════════════════════════════════════════════════════
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  s.background = { color: C.navy };
  addHeaderBar(s, "10-Step Systematic Approach", "Use this sequence every single time — never skip a step");

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    ["Rate",         "Count large boxes between R waves → 300/boxes", C.teal],
    ["Rhythm",       "Regular or irregular? P before every QRS?",     C.teal],
    ["P Wave",       "Present, upright I & II, normal morphology?",   C.teal],
    ["PR Interval",  "Normal 90–200 msec? Prolonged = AV block",      C.amber],
    ["QRS Duration", "< 110 msec? Widened = BBB / preexcitation",     C.amber],
    ["QRS Axis",     "Leads I & aVF: both positive = normal axis",    C.amber],
    ["ST Segment",   "Isoelectric? Elevation or depression?",         C.crimsonSoft],
    ["T Wave",       "Upright I, II, V3–V6? Inverted = ischaemia?",   C.crimsonSoft],
    ["QT Interval",  "Calculate QTc — prolonged = TdP risk",          C.crimsonSoft],
    ["Interpretation","Synthesise all findings → clinical diagnosis",  C.steelGray],
  ];

  steps.forEach(([ title, desc, col ], i) => {
    const column = i < 5 ? 0 : 1;
    const row    = i < 5 ? i : i - 5;
    const x = column === 0 ? 0.25 : 5.1;
    const y = 1.2 + row * 0.82;
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    addStepBadge(s, i + 1, x + 0.1, y + 0.09, col);
    s.addText(title, {
      x: x + 0.75, y: y + 0.04, w: 3.7, h: 0.28,
      fontSize: 13, bold: true, color: col, margin: 0
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    s.addText(desc, {
      x: x + 0.75, y: y + 0.35, w: 3.75, h: 0.3,
      fontSize: 10.5, color: C.offWhite, margin: 0
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 8 – Heart Rate & Rhythm
// ══════════════════════════════════════════════════════════════════════════
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  s.background = { color: C.navy };
  addHeaderBar(s, "Steps 1 & 2: Rate and Rhythm", "Foundation of every ECG read");

  // Rate methods
  s.addText("HEART RATE METHODS", {
    x: 0.3, y: 1.25, w: 4.5, h: 0.32,
    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 2, margin: 0
  });
  const rateMethods = [
    ["Quick Method", "300 ÷ number of large boxes between R waves\n300 → 150 → 100 → 75 → 60 → 50"],
    ["Precise Method", "60,000 ÷ R-R interval in milliseconds"],
    ["Irregular Rhythm", "Count QRS complexes in 10 sec strip × 6"],
  ];
  rateMethods.forEach(([m, d], i) => {
    const y = 1.62 + i * 0.88;
    addCard(s, 0.3, y, 4.5, 0.76, C.navyMid);
    addAccentStripe(s, 0.3, y, 0.76, C.teal);
    s.addText(m, { x: 0.55, y: y + 0.06, w: 4.0, h: 0.26, fontSize: 12.5, bold: true, color: C.teal, margin: 0 });
    s.addText(d, { x: 0.55, y: y + 0.35, w: 4.1, h: 0.36, fontSize: 11, color: C.offWhite, margin: 0 });
  });

  // Rhythm criteria
  s.addText("NORMAL SINUS RHYTHM CRITERIA", {
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    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 2, margin: 0
  });
  const nsrItems = [
    "Regular rhythm at 60–100 bpm",
    "P wave upright in leads I, II, aVF",
    "P wave inverted in aVR",
    "Every P wave followed by a QRS",
    "Every QRS preceded by a P wave",
    "PR interval 120–200 msec",
    "QRS duration < 120 msec",
    "Normal axis (−30° to +90°)",
  ];
  addCard(s, 5.1, 1.62, 4.7, 3.6, C.navyMid);
  addAccentStripe(s, 5.1, 1.62, 3.6, C.amber);
  s.addText(nsrItems.map(t => ({ text: t, options: { bullet: { indent: 15 }, breakLine: true } }))
    .map((o, i) => i === nsrItems.length - 1 ? { ...o, options: { ...o.options, breakLine: false } } : o),
    { x: 5.35, y: 1.72, w: 4.3, h: 3.3, fontSize: 12, color: C.offWhite, margin: 0, lineSpacingMultiple: 1.4 }
  );

  // Rate quick table
  addCard(s, 0.3, 5.12, 4.5, 0.44, C.navyLight);
  s.addText("< 60 bpm = Bradycardia   |   60–100 = Normal   |   > 100 bpm = Tachycardia", {
    x: 0.35, y: 5.15, w: 4.4, h: 0.38,
    fontSize: 11, color: C.amber, bold: true, align: "center", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 9 – QRS Axis
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "Step 6: QRS Axis", "Use leads I and aVF for rapid axis determination");

  // Axis quadrant diagram using shapes
  const cx = 5.0, cy = 3.2, r = 1.6;
  // Circle background
  s.addShape(pres.shapes.ELLIPSE, {
    x: cx - r, y: cy - r, w: r * 2, h: r * 2,
    fill: { color: C.navyMid }, line: { color: C.steelGray, pt: 1.5 }
  });
  // Horizontal axis
  s.addShape(pres.shapes.LINE, { x: cx - r, y: cy, w: r * 2, h: 0, line: { color: C.steelGray, pt: 1.5 } });
  // Vertical axis
  s.addShape(pres.shapes.LINE, { x: cx, y: cy - r, w: 0, h: r * 2, line: { color: C.steelGray, pt: 1.5 } });

  // Quadrant labels
  s.addText("NORMAL\n(−30° to +90°)\nI ✓  aVF ✓", { x: cx + 0.1, y: cy + 0.08, w: 1.5, h: 0.7, fontSize: 10, color: C.teal, bold: true, align: "center", margin: 0 });
  s.addText("LAD\n(< −30°)\nI ✓  aVF ✗", { x: cx - 1.55, y: cy + 0.08, w: 1.45, h: 0.7, fontSize: 10, color: C.amber, bold: true, align: "center", margin: 0 });
  s.addText("RAD\n(> +90°)\nI ✗  aVF ✓", { x: cx + 0.1, y: cy - 0.78, w: 1.45, h: 0.7, fontSize: 10, color: C.crimsonSoft, bold: true, align: "center", margin: 0 });
  s.addText("EXTREME\nNW axis\nI ✗  aVF ✗", { x: cx - 1.55, y: cy - 0.78, w: 1.45, h: 0.7, fontSize: 10, color: C.steelGray, bold: true, align: "center", margin: 0 });

  // Lead labels
  s.addText("aVF (+)", { x: cx + 0.1, y: cy + r + 0.05, w: 0.9, h: 0.28, fontSize: 10, color: C.steelGray, margin: 0 });
  s.addText("aVF (−)", { x: cx + 0.1, y: cy - r - 0.3, w: 0.9, h: 0.28, fontSize: 10, color: C.steelGray, margin: 0 });
  s.addText("I (+)", { x: cx + r + 0.05, y: cy, w: 0.7, h: 0.28, fontSize: 10, color: C.steelGray, margin: 0 });
  s.addText("I (−)", { x: cx - r - 0.75, y: cy, w: 0.7, h: 0.28, fontSize: 10, color: C.steelGray, margin: 0 });

  // LAD causes
  s.addText("LEFT AXIS DEVIATION (LAD)", {
    x: 0.25, y: 1.2, w: 4.3, h: 0.32,
    fontSize: 11, bold: true, color: C.amber, charSpacing: 1.5, margin: 0
  });
  const ladCauses = ["Left anterior fascicular block (most common)", "Left ventricular hypertrophy", "Inferior STEMI", "WPW (right-sided accessory pathway)"];
  addCard(s, 0.25, 1.55, 4.3, 1.6, C.navyMid);
  addAccentStripe(s, 0.25, 1.55, 1.6, C.amber);
  s.addText(ladCauses.map((t, i) => ({ text: t, options: { bullet: { indent: 15 }, breakLine: i < ladCauses.length - 1 } })), {
    x: 0.5, y: 1.65, w: 3.9, h: 1.4, fontSize: 11.5, color: C.offWhite, lineSpacingMultiple: 1.45, margin: 0
  });

  // RAD causes
  s.addText("RIGHT AXIS DEVIATION (RAD)", {
    x: 0.25, y: 3.28, w: 4.3, h: 0.32,
    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 1.5, margin: 0
  });
  const radCauses = ["Right ventricular hypertrophy", "Left posterior fascicular block", "Pulmonary embolism / cor pulmonale", "Normal in children & tall thin adults"];
  addCard(s, 0.25, 3.62, 4.3, 1.6, C.navyMid);
  addAccentStripe(s, 0.25, 3.62, 1.6, C.crimsonSoft);
  s.addText(radCauses.map((t, i) => ({ text: t, options: { bullet: { indent: 15 }, breakLine: i < radCauses.length - 1 } })), {
    x: 0.5, y: 3.72, w: 3.9, h: 1.4, fontSize: 11.5, color: C.offWhite, lineSpacingMultiple: 1.45, margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 10 – Bundle Branch Blocks
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "Bundle Branch Blocks", "QRS ≥ 120 msec + specific morphology");

  // RBBB left column
  s.addText("RIGHT BUNDLE BRANCH BLOCK", {
    x: 0.25, y: 1.2, w: 4.6, h: 0.32,
    fontSize: 11, bold: true, color: C.amber, charSpacing: 1.5, margin: 0
  });
  addCard(s, 0.25, 1.55, 4.6, 3.75, C.navyMid);
  addAccentStripe(s, 0.25, 1.55, 3.75, C.amber);

  const rbbItems = [
    ["QRS Duration", "≥ 120 msec (3 small boxes)"],
    ["V1 Pattern",   "RSR' – 'rabbit ears' (M-shape)"],
    ["I, V5, V6",    "Wide, slurred S wave"],
    ["T waves",      "Inversion V1–V3 (secondary change)"],
    ["Causes",       "PE, cor pulmonale, congenital, ischaemia, normal variant"],
    ["Mnemonic",     "R in the Right: RSR' in V1"],
  ];
  rbbItems.forEach(([k, v], i) => {
    const y = 1.7 + i * 0.55;
    s.addText(k + ": ", { x: 0.5, y, w: 1.5, h: 0.27, fontSize: 11.5, bold: true, color: C.amber, margin: 0 });
    s.addText(v,        { x: 1.9, y, w: 2.8, h: 0.27, fontSize: 11.5, color: C.offWhite, margin: 0 });
  });

  // LBBB right column
  s.addText("LEFT BUNDLE BRANCH BLOCK", {
    x: 5.15, y: 1.2, w: 4.6, h: 0.32,
    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 1.5, margin: 0
  });
  addCard(s, 5.15, 1.55, 4.6, 3.75, C.navyMid);
  addAccentStripe(s, 5.15, 1.55, 3.75, C.crimsonSoft);

  const lbbItems = [
    ["QRS Duration", "≥ 120 msec"],
    ["V1 Pattern",   "Broad QS or rS (W-shape)"],
    ["I, V5, V6",    "Broad, notched R; no Q waves in V5-V6"],
    ["T waves",      "Discordant (opposite to QRS direction)"],
    ["Significance", "Almost always pathological (CAD, cardiomyopathy, HTN)"],
    ["Mnemonic",     "WiLLiaM MoRRoW: W in V1, M in V6 for LBBB"],
  ];
  lbbItems.forEach(([k, v], i) => {
    const y = 1.7 + i * 0.55;
    s.addText(k + ": ", { x: 5.4, y, w: 1.5, h: 0.27, fontSize: 11.5, bold: true, color: C.crimsonSoft, margin: 0 });
    s.addText(v,        { x: 6.8, y, w: 2.8, h: 0.27, fontSize: 11.5, color: C.offWhite, margin: 0 });
  });

  // Bottom note
  addCard(s, 0.25, 5.38, 9.5, 0.2, C.navyLight);
  s.addText("New LBBB + chest pain = treat as STEMI equivalent  |  Apply Sgarbossa criteria for ischaemia diagnosis", {
    x: 0.35, y: 5.39, w: 9.3, h: 0.18,
    fontSize: 10.5, color: C.amber, bold: true, align: "center", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 11 – Ischaemia & Infarction
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "Ischaemia & Infarction Patterns", "ST changes and Q waves localise the territory");

  // Timeline of STEMI changes
  s.addText("STEMI EVOLUTION", {
    x: 0.25, y: 1.2, w: 9.5, h: 0.3,
    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 2, margin: 0
  });

  const stemiStages = [
    ["Minutes",       "Hyperacute T waves\n(tall, peaked)",      C.amber],
    ["Hours",         "ST elevation\n(convex / tombstone)",       C.crimson],
    ["Hours–Days",    "T wave inversion",                         C.crimsonSoft],
    ["Days–Weeks",    "Pathological Q waves\nform",               C.steelGray],
    ["Persistent",    "Q waves remain\n(scar)",                   C.navyLight],
  ];
  stemiStages.forEach(([t, d, col], i) => {
    const x = 0.25 + i * 1.9;
    addCard(s, x, 1.55, 1.75, 1.3, col === C.navyLight ? C.navyMid : C.navyMid);
    addAccentStripe(s, x, 1.55, 1.3, col);
    s.addText(t, { x: x + 0.15, y: 1.6, w: 1.45, h: 0.3, fontSize: 11, bold: true, color: col, margin: 0 });
    s.addText(d, { x: x + 0.15, y: 1.92, w: 1.5, h: 0.55, fontSize: 10.5, color: C.offWhite, margin: 0 });
  });

  // Territory table
  s.addText("INFARCT LOCALISATION", {
    x: 0.25, y: 3.0, w: 9.5, h: 0.3,
    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 2, margin: 0
  });

  const terrRows = [
    [{ text: "Territory",  options: { bold: true, color: C.white, fill: { color: C.crimson } } },
     { text: "Leads",      options: { bold: true, color: C.white, fill: { color: C.crimson } } },
     { text: "Artery",     options: { bold: true, color: C.white, fill: { color: C.crimson } } }],
    ["Inferior",    "II, III, aVF",   "RCA (80%) / LCx (20%)"],
    ["Lateral",     "I, aVL, V5-V6",  "LCx or diagonal"],
    ["Anterior",    "V1–V4",          "LAD"],
    ["Septal",      "V1–V2",          "Septal perforators (LAD)"],
    ["Posterior",   "Tall R + ST↓ in V1-V2", "RCA or LCx"],
    ["Right Ventricle", "V4R (RV lead)",  "RCA (proximal)"],
  ];
  const formattedRows = terrRows.map((row, i) => {
    if (i === 0) return row;
    return (row as string[]).map((cell, j) => ({
      text: cell,
      options: { color: j === 0 ? C.teal : j === 1 ? C.offWhite : C.steelGray }
    }));
  });

  s.addTable(formattedRows, {
    x: 0.25, y: 3.33, w: 9.5, h: 2.2,
    border: { pt: 0.5, color: C.navyLight },
    fill: { color: C.navyMid },
    colW: [2.5, 3.5, 3.5],
    fontSize: 12,
    rowH: 0.34,
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 12 – Common Arrhythmias Quick Reference
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "Common Arrhythmias – Quick Reference", "Recognise the pattern, identify the mechanism");

  const arrhythmias = [
    { name: "Sinus Tachycardia",  features: "Rate > 100, normal P waves, regular, narrow QRS",                    color: C.teal },
    { name: "Sinus Bradycardia",  features: "Rate < 60, normal P waves, otherwise normal",                        color: C.teal },
    { name: "Atrial Fibrillation", features: "Irregularly irregular, no P waves, variable rate, narrow QRS",      color: C.amber },
    { name: "Atrial Flutter",     features: "Sawtooth at 300 bpm, usually 2:1 block → ventricular rate ~150",    color: C.amber },
    { name: "SVT (AVNRT/AVRT)",   features: "Regular narrow-complex tachycardia 150–250 bpm, P buried in QRS",   color: C.amber },
    { name: "VT",                 features: "≥3 wide QRS > 100 bpm, AV dissociation, fusion/capture beats",      color: C.crimsonSoft },
    { name: "VF",                 features: "Chaotic irregular wide complexes, no output – cardiac arrest",       color: C.crimson },
    { name: "1° AV Block",        features: "PR > 200 msec, all P waves conduct, usually benign",                color: C.steelGray },
    { name: "Mobitz I (Wenckebach)", features: "Progressive PR prolongation → dropped QRS → repeats",            color: C.amber },
    { name: "Mobitz II",          features: "Fixed PR, sudden dropped QRS – below AV node, serious",             color: C.crimsonSoft },
    { name: "Complete Heart Block", features: "P–QRS complete dissociation, escape rhythm – emergency",          color: C.crimson },
  ];

  // Two columns
  const col1 = arrhythmias.slice(0, 6);
  const col2 = arrhythmias.slice(6);

  [[col1, 0.25], [col2, 5.1]].forEach(([items, xBase]) => {
    (items as typeof arrhythmias).forEach((arr, i) => {
      const y = 1.2 + i * 0.7;
      addCard(s, xBase as number, y, 4.6, 0.6, C.navyMid);
      addAccentStripe(s, xBase as number, y, 0.6, arr.color);
      s.addText(arr.name, {
        x: (xBase as number) + 0.2, y: y + 0.04, w: 4.2, h: 0.25,
        fontSize: 12, bold: true, color: arr.color, margin: 0
      });
      s.addText(arr.features, {
        x: (xBase as number) + 0.2, y: y + 0.31, w: 4.2, h: 0.25,
        fontSize: 10.5, color: C.offWhite, margin: 0
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 13 – Electrolyte & Drug Effects
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "Electrolyte & Drug Effects on ECG", "High-yield for exams and clinical practice");

  // Electrolytes table
  s.addText("ELECTROLYTES", {
    x: 0.25, y: 1.22, w: 5.5, h: 0.3,
    fontSize: 11, bold: true, color: C.teal, charSpacing: 2, margin: 0
  });
  const elecRows = [
    [{ text: "Condition", options: { bold: true, color: C.white, fill: { color: C.navyLight } } },
     { text: "Key ECG Finding", options: { bold: true, color: C.white, fill: { color: C.navyLight } } }],
    [{ text: "Hyperkalemia (early)",  options: { color: C.amber } }, { text: "Tall peaked narrow T waves", options: { color: C.offWhite } }],
    [{ text: "Hyperkalemia (severe)", options: { color: C.crimson } }, { text: "Widened QRS → sine wave → VF", options: { color: C.offWhite } }],
    [{ text: "Hypokalemia",           options: { color: C.teal } }, { text: "Flat T waves, prominent U waves, long QU", options: { color: C.offWhite } }],
    [{ text: "Hypercalcemia",         options: { color: C.amber } }, { text: "Short QT interval (short ST segment)", options: { color: C.offWhite } }],
    [{ text: "Hypocalcemia",          options: { color: C.steelGray } }, { text: "Long QT interval (long ST segment)", options: { color: C.offWhite } }],
    [{ text: "Hypomagnesemia",        options: { color: C.teal } }, { text: "Long QT, TdP risk (often + hypoK)", options: { color: C.offWhite } }],
  ];
  s.addTable(elecRows, {
    x: 0.25, y: 1.55, w: 4.6, h: 2.8,
    border: { pt: 0.5, color: C.navyLight },
    fill: { color: C.navyMid },
    colW: [2.2, 2.4],
    fontSize: 11.5, rowH: 0.39,
  });

  // Drugs table
  s.addText("DRUGS", {
    x: 5.15, y: 1.22, w: 4.6, h: 0.3,
    fontSize: 11, bold: true, color: C.amber, charSpacing: 2, margin: 0
  });
  const drugRows = [
    [{ text: "Drug", options: { bold: true, color: C.white, fill: { color: C.navyLight } } },
     { text: "ECG Effect", options: { bold: true, color: C.white, fill: { color: C.navyLight } } }],
    [{ text: "Digoxin",        options: { color: C.amber } }, { text: "Reverse tick ST↓, short QT, ↑PR", options: { color: C.offWhite } }],
    [{ text: "Beta-blockers",  options: { color: C.steelGray } }, { text: "Bradycardia, ↑PR", options: { color: C.offWhite } }],
    [{ text: "Class Ia (quinidine)", options: { color: C.crimsonSoft } }, { text: "↑QT, wide QRS", options: { color: C.offWhite } }],
    [{ text: "Class III (amiodarone)", options: { color: C.crimsonSoft } }, { text: "↑QT, bradycardia", options: { color: C.offWhite } }],
    [{ text: "TCAs",           options: { color: C.crimson } }, { text: "Sinus tach, wide QRS, ↑QT, RAD", options: { color: C.offWhite } }],
    [{ text: "Fluoroquinolones / antipsychotics", options: { color: C.amber } }, { text: "↑QT → TdP risk", options: { color: C.offWhite } }],
  ];
  s.addTable(drugRows, {
    x: 5.15, y: 1.55, w: 4.6, h: 2.8,
    border: { pt: 0.5, color: C.navyLight },
    fill: { color: C.navyMid },
    colW: [2.3, 2.3],
    fontSize: 11.5, rowH: 0.39,
  });

  // Special patterns box
  s.addText("SPECIAL PATTERNS", {
    x: 0.25, y: 4.5, w: 9.5, h: 0.3,
    fontSize: 11, bold: true, color: C.crimsonSoft, charSpacing: 2, margin: 0
  });
  const specials = [
    ["WPW",       "Short PR + delta wave + wide QRS",          C.amber],
    ["Brugada",   "Coved ST elevation V1-V3 + RBBB-like",      C.crimsonSoft],
    ["PE",        "Sinus tach; S1Q3T3; RBBB; T inv V1-V4",     C.teal],
    ["Hypothermia","Sinus brady + Osborn (J) waves",            C.steelGray],
  ];
  specials.forEach(([name, desc, col], i) => {
    const x = 0.25 + i * 2.45;
    addCard(s, x, 4.84, 2.3, 0.72, C.navyMid);
    addAccentStripe(s, x, 4.84, 0.72, col as string);
    s.addText(name as string, { x: x + 0.18, y: 4.89, w: 1.95, h: 0.26, fontSize: 12, bold: true, color: col as string, margin: 0 });
    s.addText(desc as string, { x: x + 0.18, y: 5.16, w: 1.95, h: 0.36, fontSize: 10, color: C.offWhite, margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 14 – Quick Clues Cheat Sheet
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  addHeaderBar(s, "ECG Quick Clues – Cheat Sheet", "One finding → think of …");

  const clues = [
    ["Delta wave + short PR",         "WPW syndrome",                C.amber],
    ["Sawtooth waves ~300 bpm",       "Atrial flutter",              C.teal],
    ["Irregularly irregular, no P",   "Atrial fibrillation",         C.teal],
    ["Progressive PR → dropped beat", "Mobitz I (Wenckebach)",       C.steelGray],
    ["Fixed PR + sudden dropped QRS", "Mobitz II",                   C.crimsonSoft],
    ["P-QRS complete dissociation",   "Complete heart block",        C.crimson],
    ["RSR' in V1 + wide S in V6",     "RBBB",                        C.amber],
    ["Broad notched R V5-V6, no Q",   "LBBB",                        C.crimsonSoft],
    ["S1Q3T3 + sinus tachycardia",    "Pulmonary embolism",          C.teal],
    ["Diffuse ST↑ + PR depression",   "Pericarditis",                C.steelGray],
    ["Tall peaked T waves",           "Hyperkalemia (early)",        C.amber],
    ["Prominent U waves",             "Hypokalemia",                 C.teal],
    ["Short QT interval",             "Hypercalcemia",               C.steelGray],
    ["Long QT + low K/Mg",            "TdP risk",                    C.crimsonSoft],
    ["Osborn (J) waves",              "Hypothermia",                 C.steelGray],
    ["Reverse tick ST depression",    "Digoxin effect",              C.amber],
  ];

  const half = 8;
  [[clues.slice(0, half), 0.25], [clues.slice(half), 5.1]].forEach(([items, xBase]) => {
    (items as typeof clues).forEach(([ecg, dx, col], i) => {
      const y = 1.2 + i * 0.52;
      addCard(s, xBase as number, y, 4.6, 0.44, C.navyMid);
      addAccentStripe(s, xBase as number, y, 0.44, col as string);
      s.addText(ecg as string, {
        x: (xBase as number) + 0.2, y: y + 0.04, w: 2.1, h: 0.36,
        fontSize: 11, color: C.offWhite, margin: 0
      });
      s.addText("→ " + (dx as string), {
        x: (xBase as number) + 2.3, y: y + 0.04, w: 2.2, h: 0.36,
        fontSize: 11, bold: true, color: col as string, margin: 0
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════
//  SLIDE 15 – Summary / Closing
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };

  // Full crimson top bar
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.18, fill: { color: C.crimson }, line: { color: C.crimson }
  });
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 5.44, w: 10, h: 0.18, fill: { color: C.crimson }, line: { color: C.crimson }
  });

  s.addText("Always Approach the ECG Systematically", {
    x: 0.5, y: 0.35, w: 9, h: 0.7,
    fontSize: 28, bold: true, color: C.white, align: "center", margin: 0
  });

  const pillars = [
    ["1  Rate",       "300 ÷ large boxes"],
    ["2  Rhythm",     "Regular? P→QRS?"],
    ["3  P Wave",     "Upright I & II?"],
    ["4  PR Interval","90–200 msec"],
    ["5  QRS",        "< 110 msec"],
    ["6  Axis",       "I & aVF positive?"],
    ["7  ST Segment", "Isoelectric?"],
    ["8  T Wave",     "Upright V3–V6?"],
    ["9  QTc",        "≤ 450 / 460 msec"],
    ["10 Synthesise", "Clinical context"],
  ];

  pillars.forEach(([step, hint], i) => {
    const col = i % 5;
    const row = Math.floor(i / 5);
    const x = 0.25 + col * 1.92;
    const y = 1.25 + row * 1.6;
    const accent = i < 3 ? C.teal : i < 6 ? C.amber : i < 9 ? C.crimsonSoft : C.steelGray;
    addCard(s, x, y, 1.78, 1.38, C.navyMid);
    s.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 1.78, h: 0.4, fill: { color: accent }, line: { color: accent }
    });
    s.addText(step, {
      x: x + 0.08, y: y + 0.06, w: 1.62, h: 0.28,
      fontSize: 12, bold: true, color: C.white, margin: 0
    });
    s.addText(hint, {
      x: x + 0.08, y: y + 0.52, w: 1.62, h: 0.72,
      fontSize: 11, color: C.steelGray, align: "center", valign: "middle", margin: 0
    });
  });

  s.addText("Based on Goldman-Cecil Medicine  |  Medical Physiology (Boron & Boulpaep)  |  Miller's Anesthesia", {
    x: 0.3, y: 5.05, w: 9.4, h: 0.28,
    fontSize: 9.5, color: C.steelGray, align: "center", italic: true, margin: 0
  });
}

// ── Write file ─────────────────────────────────────────────────────────────
const outPath = "/home/daytona/workspace/ecg-pptx/ECG_Interpretation.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("✅ Saved: " + outPath);
}).catch(err => {
  console.error("❌ Error:", err);
  process.exit(1);
});

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/ecg-pptx/build.js'