const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Cardiac Failure and Its Management";
pres.author = "Medical Education";

// ─── Color Palette ────────────────────────────────────────────────
const DARK_BG   = "0D1B2A";   // deep navy
const MID_BG    = "1B2A3B";   // medium navy
const ACCENT    = "E63946";   // vivid red
const ACCENT2   = "457B9D";   // muted blue
const WHITE     = "FFFFFF";
const LIGHT_TXT = "A8DADC";   // cool mint
const YELLOW    = "F4D35E";   // warm highlight
const GREY_BG   = "1F2F42";   // card background
const LIGHT_BG  = "EBF4FA";   // light slide bg
const DARK_TXT  = "1B2A3B";

// ─── Helpers ──────────────────────────────────────────────────────
function addBackground(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color } });
}

function addAccentBar(slide, color = ACCENT) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: "100%", fill: { color } });
}

function slideTitle(slide, txt, color = WHITE) {
  slide.addText(txt, {
    x: 0.3, y: 0.18, w: 9.4, h: 0.65,
    fontSize: 28, bold: true, color, fontFace: "Calibri", margin: 0
  });
  slide.addShape(pres.ShapeType.line, {
    x: 0.3, y: 0.88, w: 9.4, h: 0,
    line: { color: ACCENT, width: 2.5 }
  });
}

function card(slide, x, y, w, h, bg = GREY_BG) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h, rectRadius: 0.08,
    fill: { color: bg }, line: { color: ACCENT2, width: 1 }
  });
}

function bulletList(slide, items, x, y, w, h, opts = {}) {
  const textItems = items.map((t, i) => ({
    text: t,
    options: { bullet: { indent: 10 }, breakLine: i < items.length - 1, fontSize: opts.fontSize || 13.5, color: opts.color || WHITE, fontFace: "Calibri" }
  }));
  slide.addText(textItems, { x, y, w, h, valign: "top", ...opts });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);

  // Red diagonal stripe top-right
  s.addShape(pres.ShapeType.rect, { x: 7, y: 0, w: 3, h: 5.625, fill: { color: ACCENT }, rotate: 0, transparency: 85 });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: 10, h: 0.825, fill: { color: MID_BG } });

  s.addText("CARDIAC FAILURE", {
    x: 0.5, y: 1.2, w: 9, h: 0.85,
    fontSize: 46, bold: true, color: WHITE, fontFace: "Calibri", align: "center", charSpacing: 4
  });
  s.addText("AND ITS MANAGEMENT", {
    x: 0.5, y: 2.1, w: 9, h: 0.65,
    fontSize: 26, bold: false, color: LIGHT_TXT, fontFace: "Calibri", align: "center", charSpacing: 2
  });

  // Divider
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 2.85, w: 3, h: 0.06, fill: { color: ACCENT } });

  s.addText("A Comprehensive Clinical Overview", {
    x: 0.5, y: 3.05, w: 9, h: 0.4,
    fontSize: 15, color: YELLOW, fontFace: "Calibri", align: "center", italic: true
  });

  // Bottom strip
  s.addText("Sources: Braunwald's Heart Disease | Harrison's Principles | Textbook of Family Medicine", {
    x: 0.3, y: 4.88, w: 9.4, h: 0.3,
    fontSize: 9, color: LIGHT_TXT, fontFace: "Calibri", align: "right"
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 — OUTLINE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Table of Contents");

  const topics = [
    ["01", "Definition & Overview"],
    ["02", "Classification (HFrEF / HFpEF / HFmrEF)"],
    ["03", "Epidemiology"],
    ["04", "Etiology & Risk Factors"],
    ["05", "Pathophysiology"],
    ["06", "Clinical Features & Diagnosis"],
    ["07", "Investigations"],
    ["08", "Pharmacological Management"],
    ["09", "Non-Pharmacological & Device Therapy"],
    ["10", "Acute Decompensated Heart Failure"],
  ];

  topics.forEach(([num, title], i) => {
    const col = i < 5 ? 0 : 1;
    const row = i % 5;
    const x = col === 0 ? 0.5 : 5.3;
    const y = 1.1 + row * 0.8;
    card(s, x, y, 4.6, 0.65, GREY_BG);
    s.addText(num, { x: x + 0.1, y: y + 0.08, w: 0.55, h: 0.48, fontSize: 18, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
    s.addText(title, { x: x + 0.7, y: y + 0.1, w: 3.8, h: 0.45, fontSize: 13, color: WHITE, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 — DEFINITION
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Definition & Overview");

  // Big quote box
  card(s, 0.5, 1.05, 9, 1.5, MID_BG);
  s.addText('"Heart failure is a clinical syndrome resulting from the inability of the heart to meet the metabolic requirements of the body at normal filling pressures."', {
    x: 0.65, y: 1.12, w: 8.7, h: 1.35,
    fontSize: 14.5, italic: true, color: YELLOW, fontFace: "Calibri", valign: "middle", align: "center"
  });

  const points = [
    "HF can arise from LV systolic or diastolic dysfunction",
    "HFpEF (preserved EF >45-50%): impaired LV filling/relaxation",
    "HFrEF (reduced EF <40%): reduced LV contraction",
    "Fluid retention & pulmonary congestion are hallmarks — but may be absent",
    "Term 'heart failure' is preferred over 'congestive heart failure'",
    "Mortality ~50% within 5 years of diagnosis"
  ];
  bulletList(s, points, 0.5, 2.75, 9, 2.6, { fontSize: 13.5 });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 — CLASSIFICATION
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Classification of Heart Failure");

  const categories = [
    {
      label: "HFrEF",
      sub: "Reduced EF",
      ef: "EF < 40%",
      color: ACCENT,
      points: ["Dilated cardiomyopathy", "Post-MI remodeling", "Volume overload", "Best-studied group", "Responds to neurohormonal blockade"]
    },
    {
      label: "HFmrEF",
      sub: "Mildly Reduced EF",
      ef: "EF 40–49%",
      color: YELLOW,
      points: ["Intermediate phenotype", "Often ischemic etiology", "Emerging evidence for", "same treatments as HFrEF", ""]
    },
    {
      label: "HFpEF",
      sub: "Preserved EF",
      ef: "EF ≥ 50%",
      color: ACCENT2,
      points: ["Hypertension-related", "Elderly / obese", "Impaired relaxation", "Tx targets comorbidities", "SGLT2i showing benefit"]
    }
  ];

  categories.forEach((c, i) => {
    const x = 0.4 + i * 3.2;
    card(s, x, 1.05, 3.0, 4.25, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x, y: 1.05, w: 3.0, h: 0.55, fill: { color: c.color } });
    s.addText(c.label, { x, y: 1.05, w: 3.0, h: 0.55, fontSize: 20, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(c.sub, { x, y: 1.62, w: 3.0, h: 0.35, fontSize: 11, color: LIGHT_TXT, align: "center", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.roundRect, { x: x + 0.6, y: 2.0, w: 1.8, h: 0.38, rectRadius: 0.05, fill: { color: c.color }, transparency: 25 });
    s.addText(c.ef, { x: x + 0.6, y: 2.0, w: 1.8, h: 0.38, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    c.points.forEach((pt, j) => {
      if (pt) s.addText("• " + pt, { x: x + 0.1, y: 2.5 + j * 0.38, w: 2.8, h: 0.36, fontSize: 11, color: WHITE, fontFace: "Calibri" });
    });
  });

  // Bottom: NYHA
  card(s, 0.4, 5.1, 9.2, 0.38, MID_BG);
  s.addText("NYHA Class: I (No symptoms) → II (Mild) → III (Moderate) → IV (Severe at rest)", {
    x: 0.5, y: 5.13, w: 9, h: 0.32, fontSize: 12, color: YELLOW, fontFace: "Calibri", align: "center"
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 — EPIDEMIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Epidemiology");

  const stats = [
    { icon: "64M+", label: "People affected\nworldwide" },
    { icon: "650K", label: "New cases per year\n(United States)" },
    { icon: "300K", label: "Deaths per year\n(United States)" },
    { icon: "50%", label: "5-year mortality\nrate" },
    { icon: "25%", label: "1-month re-\nhospitalization rate" },
  ];

  stats.forEach((st, i) => {
    const x = 0.4 + i * 1.88;
    card(s, x, 1.1, 1.7, 2.2, MID_BG);
    s.addShape(pres.ShapeType.rect, { x, y: 1.1, w: 1.7, h: 0.08, fill: { color: ACCENT } });
    s.addText(st.icon, { x, y: 1.25, w: 1.7, h: 0.8, fontSize: 22, bold: true, color: YELLOW, align: "center", fontFace: "Calibri" });
    s.addText(st.label, { x, y: 2.08, w: 1.7, h: 1.05, fontSize: 11, color: LIGHT_TXT, align: "center", fontFace: "Calibri" });
  });

  s.addText("Risk Factors", { x: 0.4, y: 3.55, w: 9.2, h: 0.38, fontSize: 16, bold: true, color: WHITE, fontFace: "Calibri" });
  const riskCols = [
    ["Coronary Artery Disease", "Hypertension", "Diabetes Mellitus", "Obesity"],
    ["Valvular Heart Disease", "Cardiomyopathies", "Congenital Heart Defects", "Alcohol / Drug Abuse"],
    ["Atrial Fibrillation", "Renal Failure", "Thyroid Disorders", "Sleep-Disordered Breathing"]
  ];
  riskCols.forEach((col, i) => {
    card(s, 0.4 + i * 3.2, 3.95, 3.0, 1.5, GREY_BG);
    bulletList(s, col, 0.5 + i * 3.2, 3.98, 2.85, 1.45, { fontSize: 11.5 });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 — PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Pathophysiology");

  // Central flow diagram
  const steps = [
    { label: "Precipitating Injury", sub: "CAD, MI, HTN, valvular disease,\nanemia, cardiomyopathy", x: 3.4, y: 1.05, color: ACCENT },
    { label: "LV Remodeling", sub: "Stretching, dilation,\nreduced LV function", x: 3.4, y: 2.1, color: ACCENT2 },
    { label: "Neurohormonal Activation", sub: "RAAS, SNS, Endothelin-1,\nInflammatory cytokines", x: 3.4, y: 3.15, color: "7B2D8B" },
    { label: "Adverse Cardiac Effects", sub: "Apoptosis, fibrosis, hypertrophy,\narrhythmias, further dysfunction", x: 3.4, y: 4.2, color: ACCENT },
  ];

  steps.forEach((st, i) => {
    card(s, st.x, st.y, 3.2, 0.85, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x: st.x, y: st.y, w: 0.08, h: 0.85, fill: { color: st.color } });
    s.addText(st.label, { x: st.x + 0.18, y: st.y + 0.04, w: 3.0, h: 0.35, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri" });
    s.addText(st.sub, { x: st.x + 0.18, y: st.y + 0.38, w: 3.0, h: 0.45, fontSize: 10, color: LIGHT_TXT, fontFace: "Calibri" });
    if (i < 3) {
      s.addShape(pres.ShapeType.line, { x: 5, y: st.y + 0.85, w: 0, h: 0.22, line: { color: ACCENT, width: 2 } });
    }
  });

  // Right panel: key mediators
  card(s, 7.0, 1.05, 2.7, 4.0, MID_BG);
  s.addText("Key Mediators", { x: 7.05, y: 1.1, w: 2.6, h: 0.35, fontSize: 13, bold: true, color: YELLOW, fontFace: "Calibri" });
  const mediators = [
    "Angiotensin II: apoptosis, hypertrophy, fibrosis",
    "Aldosterone: sodium retention, fibrosis",
    "Catecholamines: receptor downregulation, toxicity",
    "MMP / TIMMP: cardiac fibrosis, collagen deposition",
    "BNP / NT-proBNP: released due to wall stress",
    "Endothelin-1: vasoconstriction"
  ];
  mediators.forEach((m, i) => {
    s.addText("• " + m, { x: 7.1, y: 1.5 + i * 0.55, w: 2.55, h: 0.5, fontSize: 10.5, color: WHITE, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Clinical Features & Diagnosis");

  const sections = [
    {
      title: "Symptoms", color: ACCENT, x: 0.35, items: [
        "Dyspnea on exertion", "Orthopnoea", "Paroxysmal nocturnal dyspnea", "Fatigue & exercise intolerance",
        "Ankle swelling", "Nocturia", "Anorexia / nausea", "Palpitations"
      ]
    },
    {
      title: "Signs", color: ACCENT2, x: 3.55, items: [
        "Tachycardia, tachypnoea", "Raised JVP", "S3 gallop rhythm", "Displaced apex beat",
        "Pitting oedema", "Pulmonary crackles", "Pleural effusion", "Hepatomegaly / ascites"
      ]
    },
    {
      title: "Diagnostic Criteria\n(Framingham)", color: "2E8B57", x: 6.75, items: [
        "Major: PND, raised JVP, S3, cardiomegaly", "Major: Pulmonary oedema, HJR+", "Minor: Bilateral ankle oedema",
        "Minor: Nocturnal cough", "Minor: Dyspnoea on exertion", "2 major OR 1 major + 2 minor", "to diagnose HF", ""
      ]
    }
  ];

  sections.forEach((sec) => {
    card(s, sec.x, 1.05, 3.05, 4.4, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x: sec.x, y: 1.05, w: 3.05, h: 0.5, fill: { color: sec.color } });
    s.addText(sec.title, { x: sec.x + 0.05, y: 1.05, w: 2.95, h: 0.5, fontSize: 14, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    sec.items.forEach((item, j) => {
      if (item) s.addText("• " + item, { x: sec.x + 0.1, y: 1.65 + j * 0.44, w: 2.85, h: 0.42, fontSize: 11, color: WHITE, fontFace: "Calibri" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 — INVESTIGATIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Investigations");

  const groups = [
    {
      title: "Biomarkers", color: ACCENT, items: [
        "BNP >100 pg/mL: suggests HF",
        "NT-proBNP >300 pg/mL: acute HF",
        "Troponin I/T: myocardial injury",
        "Na, K, Cr, eGFR (renal monitoring)",
        "LFTs (hepatic congestion)",
        "TFTs, FBC, HbA1c, Lipids"
      ]
    },
    {
      title: "ECG", color: ACCENT2, items: [
        "LVH pattern",
        "LBBB (CRT candidacy)",
        "Atrial fibrillation",
        "Q waves (prior MI)",
        "ST-T wave changes",
        "QT prolongation"
      ]
    },
    {
      title: "Echocardiography", color: YELLOW, items: [
        "EF measurement (key!)",
        "LV size & wall motion",
        "Diastolic function (E/A, E/e')",
        "Valvular abnormalities",
        "Pericardial effusion",
        "RV function (TAPSE)"
      ]
    },
    {
      title: "Imaging", color: "2E8B57", items: [
        "CXR: cardiomegaly, pulm oedema,\n  Kerley B lines, pleural effusion",
        "MRI: gold standard for structure/function",
        "CTCA: coronary anatomy",
        "Nuclear imaging: viability"
      ]
    }
  ];

  groups.forEach((g, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.35 + col * 4.95;
    const y = 1.05 + row * 2.3;
    card(s, x, y, 4.7, 2.15, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.7, h: 0.42, fill: { color: g.color } });
    s.addText(g.title, { x, y, w: 4.7, h: 0.42, fontSize: 14, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    g.items.forEach((item, j) => {
      s.addText("• " + item, { x: x + 0.1, y: y + 0.48 + j * 0.28, w: 4.5, h: 0.28, fontSize: 10.5, color: WHITE, fontFace: "Calibri" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 — PHARMACOLOGICAL MANAGEMENT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Pharmacological Management — HFrEF");

  // Header
  card(s, 0.35, 1.05, 9.3, 0.42, MID_BG);
  s.addText("Guideline-Directed Medical Therapy (GDMT) — The Four Pillars", {
    x: 0.4, y: 1.08, w: 9.2, h: 0.36, fontSize: 13, bold: true, color: YELLOW, align: "center", fontFace: "Calibri"
  });

  const drugs = [
    {
      class: "ACE Inhibitors / ARBs / ARNI",
      color: ACCENT,
      mechanism: "Block RAAS → reduce preload/afterload, reverse remodeling",
      examples: "Enalapril 2.5-20mg BD | Lisinopril 5-40mg OD\nValsartan/Sacubitril (ARNI): 24/26 - 97/103mg BD",
      trial: "CONSENSUS: 40% mortality reduction\nSOLVD, PARADIGM-HF trials"
    },
    {
      class: "Beta-Blockers",
      color: ACCENT2,
      mechanism: "Block SNS activation → reduce HR, BP, reverse remodeling",
      examples: "Carvedilol 3.125-25mg BD\nMetoprolol succinate 12.5-200mg OD\nBisoprolol 1.25-10mg OD",
      trial: "COPERNICUS: 35% mortality reduction\nMERIT-HF, CIBIS-II trials"
    },
    {
      class: "MRA (Aldosterone Antagonists)",
      color: "2E8B57",
      mechanism: "Block aldosterone → reduce fibrosis, K+ retention, diuresis",
      examples: "Spironolactone 12.5-50mg OD\nEplerenone 25-50mg OD",
      trial: "RALES: 30% mortality reduction\nEPHESUS (post-MI), EMPHASIS-HF"
    },
    {
      class: "SGLT2 Inhibitors",
      color: YELLOW,
      mechanism: "Reduce hospitalisation, improve outcomes (all EF types)",
      examples: "Dapagliflozin 10mg OD\nEmpagliflozin 10mg OD",
      trial: "DAPA-HF, EMPEROR-Reduced:\n~25% reduction in HF hospitalisation"
    }
  ];

  drugs.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.35 + col * 4.85;
    const y = 1.6 + row * 2.05;
    card(s, x, y, 4.6, 1.9, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.38, fill: { color: d.color } });
    s.addText(d.class, { x, y, w: 4.6, h: 0.38, fontSize: 12.5, bold: true, color: d.color === YELLOW ? DARK_TXT : WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText("MOA: " + d.mechanism, { x: x + 0.1, y: y + 0.42, w: 4.4, h: 0.38, fontSize: 9.5, color: LIGHT_TXT, fontFace: "Calibri" });
    s.addText("Drugs: " + d.examples, { x: x + 0.1, y: y + 0.78, w: 4.4, h: 0.56, fontSize: 9.5, color: WHITE, fontFace: "Calibri" });
    s.addText("Evidence: " + d.trial, { x: x + 0.1, y: y + 1.36, w: 4.4, h: 0.48, fontSize: 9, color: YELLOW, fontFace: "Calibri", italic: true });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 — OTHER DRUGS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Additional Pharmacological Agents");

  const rows = [
    ["Diuretics\n(Loop / Thiazide)", "Symptom relief: reduce fluid overload\nFurosemide 20-80mg IV/PO; Bumetanide 0.5-2mg OD\nSpironolactone as K-sparing agent\nDoes NOT improve mortality — symptom benefit only", ACCENT],
    ["Digoxin", "Positive inotrope & vagotonic\n0.125-0.25mg OD (check levels)\nBenefit: reduced HF hospitalisation (DIG trial)\nUse: AF with HF, refractory HFrEF", ACCENT2],
    ["Hydralazine +\nIsosorbide Dinitrate", "Alternative if ACE-i / ARB not tolerated\nReduces preload and afterload\nA-HeFT trial: 43% mortality reduction in Black patients\nHydralazine 25-50mg TID + ISDN 20-40mg TID", "2E8B57"],
    ["Ivabradine", "If-channel blocker — reduces HR without inotropy\n5-7.5mg BD | Use if HR >70 in sinus rhythm on max BB\nSHIFT trial: reduced HF hospitalisation\nContraindicated in AF", YELLOW],
    ["Vericiguat\nOmecamtiv mecarbil", "Soluble guanylate cyclase stimulator (Vericiguat)\nMyosin activator (Omecamtiv mecarbil)\nFor worsening HFrEF; newer agents (2020-2021)\nVICTORIA, GALACTIC-HF trials", "7B2D8B"],
  ];

  rows.forEach((r, i) => {
    const y = 1.1 + i * 0.9;
    card(s, 0.35, y, 9.3, 0.82, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 2.2, h: 0.82, fill: { color: r[2], transparency: 15 } });
    s.addText(r[0], { x: 0.4, y, w: 2.1, h: 0.82, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(r[1], { x: 2.65, y: y + 0.05, w: 6.9, h: 0.73, fontSize: 10.5, color: WHITE, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 — NON-PHARM & DEVICE THERAPY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Non-Pharmacological & Device Therapy");

  // Left: lifestyle
  card(s, 0.35, 1.1, 4.5, 4.3, GREY_BG);
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.1, w: 4.5, h: 0.45, fill: { color: ACCENT2 } });
  s.addText("Lifestyle & Non-Pharmacological", { x: 0.4, y: 1.1, w: 4.4, h: 0.45, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
  const lifestyle = [
    "Fluid restriction: ~1.5-2 L/day",
    "Sodium restriction: <2g/day",
    "Daily weight monitoring (alert if >2kg in 2 days)",
    "Cardiac rehabilitation program",
    "Regular moderate aerobic exercise (NYHA I-III)",
    "Smoking cessation & alcohol avoidance",
    "Vaccination: influenza & pneumococcal",
    "Sleep-disordered breathing: CPAP if OSA",
    "Patient education & self-management plans",
  ];
  lifestyle.forEach((item, i) => {
    s.addText("• " + item, { x: 0.45, y: 1.65 + i * 0.41, w: 4.3, h: 0.38, fontSize: 11, color: WHITE, fontFace: "Calibri" });
  });

  // Right: devices
  card(s, 5.15, 1.1, 4.5, 4.3, GREY_BG);
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 1.1, w: 4.5, h: 0.45, fill: { color: ACCENT } });
  s.addText("Device Therapy", { x: 5.2, y: 1.1, w: 4.4, h: 0.45, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });

  const devices = [
    { name: "ICD", detail: "EF <35%, NYHA II-III on optimal therapy\nPrimary prevention of sudden cardiac death\nMUST trial confirmed benefit" },
    { name: "CRT-P/D", detail: "EF <35%, LBBB, QRS >120-150ms\nResynchronizes ventricular contraction\nMARIT-CRT, RAFT, CARE-HF trials" },
    { name: "LVAD", detail: "Advanced HF (NYHA IV) as bridge-to-transplant\nor destination therapy\nHEARTMATE II/3 trials" },
    { name: "Heart\nTransplant", detail: "End-stage HF, refractory to all therapy\n1-year survival ~85%, 5-year ~70%\nCareful patient selection essential" }
  ];

  devices.forEach((d, i) => {
    const y = 1.65 + i * 0.88;
    card(s, 5.2, y, 4.35, 0.78, MID_BG);
    s.addShape(pres.ShapeType.rect, { x: 5.2, y, w: 0.9, h: 0.78, fill: { color: YELLOW, transparency: 20 } });
    s.addText(d.name, { x: 5.2, y, w: 0.9, h: 0.78, fontSize: 12, bold: true, color: DARK_TXT, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(d.detail, { x: 6.15, y: y + 0.04, w: 3.32, h: 0.7, fontSize: 9.5, color: WHITE, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 12 — ACUTE DECOMPENSATED HF
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Acute Decompensated Heart Failure (ADHF)");

  // Triggers
  card(s, 0.35, 1.1, 9.3, 0.88, MID_BG);
  s.addText("Common Precipitants: ", { x: 0.45, y: 1.12, w: 1.8, h: 0.35, fontSize: 11, bold: true, color: YELLOW, fontFace: "Calibri" });
  s.addText("Non-compliance with medications / diet   |   Infection / sepsis   |   New arrhythmia (AF)   |   ACS / MI   |   Hypertensive emergency   |   Anaemia   |   PE", {
    x: 0.45, y: 1.45, w: 9.1, h: 0.48, fontSize: 10.5, color: WHITE, fontFace: "Calibri"
  });

  // Management steps
  s.addText("ACUTE MANAGEMENT — MEMORIZE", { x: 0.35, y: 2.12, w: 9.3, h: 0.35, fontSize: 12, bold: true, color: ACCENT, fontFace: "Calibri" });

  const steps = [
    { num: "A", label: "Airway & Oxygen", detail: "Supplemental O2 / CPAP / BiPAP if SpO2 <90%\nIntubation if severe respiratory failure" },
    { num: "B", label: "IV Diuretics", detail: "IV Furosemide 40-80mg bolus (or drip)\nRelieve pulmonary oedema — monitor urine output" },
    { num: "C", label: "Vasodilators", detail: "IV GTN (if BP allows) — reduce preload & afterload\nSodium nitroprusside for hypertensive ADHF" },
    { num: "D", label: "Inotropes", detail: "Dobutamine / Milrinone — cardiogenic shock\nLevosimendan: Ca sensitizer, preferred in some guidelines" },
    { num: "E", label: "Treat Cause", detail: "Revascularisation if ACS\nRate control if AF; anticoagulation if thrombus\nCorrecting anaemia, infection, etc." },
  ];

  steps.forEach((st, i) => {
    const col = i < 3 ? 0 : 1;
    const row = i < 3 ? i : i - 3;
    const x = 0.35 + col * 5.0;
    const y = 2.58 + row * 1.0;
    card(s, x, y, 4.7, 0.88, GREY_BG);
    s.addShape(pres.ShapeType.roundRect, { x, y: y + 0.1, w: 0.52, h: 0.68, rectRadius: 0.06, fill: { color: ACCENT } });
    s.addText(st.num, { x, y: y + 0.1, w: 0.52, h: 0.68, fontSize: 17, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(st.label, { x: x + 0.58, y: y + 0.06, w: 4.05, h: 0.3, fontSize: 11.5, bold: true, color: YELLOW, fontFace: "Calibri" });
    s.addText(st.detail, { x: x + 0.58, y: y + 0.36, w: 4.05, h: 0.48, fontSize: 9.5, color: WHITE, fontFace: "Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 13 — PROGNOSIS & MONITORING
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);
  addAccentBar(s);
  slideTitle(s, "Prognosis, Monitoring & Follow-up");

  const cols = [
    {
      title: "Prognostic Factors",
      color: ACCENT,
      items: [
        "LVEF < 20%: very poor prognosis",
        "NYHA Class IV: 50% 1-year mortality",
        "Elevated BNP / NT-proBNP",
        "Hyponatraemia (Na <130)",
        "Renal impairment (elevated creatinine)",
        "Wide QRS / LBBB on ECG",
        "Frequent HF hospitalizations",
        "Cardiac cachexia (weight loss)"
      ]
    },
    {
      title: "Monitoring Parameters",
      color: ACCENT2,
      items: [
        "Weight: daily — alert if >2kg gain in 2 days",
        "Blood pressure: target <130/80 mmHg",
        "Heart rate: target 50-70 bpm (NYHA II-III)",
        "Electrolytes & renal function (3-6 monthly)",
        "BNP / NT-proBNP: guide titration",
        "Echo: 3-6 months after GDMT optimization",
        "INR if on warfarin",
        "Symptom diary — NYHA class reassessment"
      ]
    },
    {
      title: "When to Refer / Escalate",
      color: YELLOW,
      items: [
        "EF <35%: refer to heart failure specialist",
        "LBBB or QRS >120ms: CRT assessment",
        "Refractory symptoms on max GDMT",
        "Recurrent hospitalizations",
        "Cardiogenic shock / LVAD discussion",
        "Transplant assessment: NYHA IV, <1yr survival",
        "Cardiac surgery: if structural cause",
        "Palliative care if end-stage"
      ]
    }
  ];

  cols.forEach((c, i) => {
    const x = 0.35 + i * 3.2;
    card(s, x, 1.05, 3.0, 4.4, GREY_BG);
    s.addShape(pres.ShapeType.rect, { x, y: 1.05, w: 3.0, h: 0.42, fill: { color: c.color } });
    s.addText(c.title, { x, y: 1.05, w: 3.0, h: 0.42, fontSize: 12.5, bold: true, color: c.color === YELLOW ? DARK_TXT : WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    c.items.forEach((item, j) => {
      s.addText("• " + item, { x: x + 0.1, y: 1.54 + j * 0.44, w: 2.82, h: 0.42, fontSize: 10, color: WHITE, fontFace: "Calibri" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 14 — SUMMARY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBackground(s, DARK_BG);

  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.5, fill: { color: ACCENT } });
  s.addText("KEY TAKEAWAYS", {
    x: 0.3, y: 0.35, w: 9.4, h: 0.8,
    fontSize: 32, bold: true, color: WHITE, align: "center", fontFace: "Calibri", charSpacing: 3
  });

  const takeaways = [
    "HF is defined by inability to meet metabolic demands; classified by EF (HFrEF / HFmrEF / HFpEF)",
    "Pathophysiology centers on LV remodeling driven by RAAS and sympathetic neurohormonal activation",
    "GDMT for HFrEF: Four Pillars — ACEi/ARB/ARNI + Beta-blocker + MRA + SGLT2 inhibitor",
    "BNP / NT-proBNP and Echo are key diagnostic and monitoring tools",
    "ICD for EF <35%; CRT for EF <35% + LBBB; LVAD/Transplant for end-stage disease",
    "ADHF management: oxygen, IV diuretics, vasodilators, inotropes, treat precipitant",
    "Mortality remains ~50% at 5 years — aggressive GDMT and close monitoring improve outcomes"
  ];

  takeaways.forEach((t, i) => {
    card(s, 0.35, 1.65 + i * 0.55, 9.3, 0.5, i % 2 === 0 ? GREY_BG : MID_BG);
    s.addText((i + 1) + ". " + t, { x: 0.5, y: 1.68 + i * 0.55, w: 9.1, h: 0.44, fontSize: 11.5, color: WHITE, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/cardiac-failure-ppt/Cardiac_Failure_and_Management.pptx" })
  .then(() => console.log("SUCCESS: Cardiac_Failure_and_Management.pptx saved"))
  .catch(err => console.error("ERROR:", err));