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

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" x 7.5"
pres.title = "Stable vs Unstable Angina";
pres.author = "Medical Education";

// ── PALETTE ──────────────────────────────────────────────────────────────────
const C = {
  navy:    "0A1628",   // dominant dark
  darkRed: "8B1A1A",   // accent
  red:     "C0392B",   // highlight
  gold:    "D4A017",   // accent
  white:   "FFFFFF",
  lightGray:"F0F4F8",
  midGray: "B0BEC5",
  text:    "1A2A3A",
  cardBg:  "132035",
  cardAlt: "1C2E48",
  teal:    "0D7377",
  amber:   "E67E22",
};

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

function sectionHeader(slide, text) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.08, fill: { color: C.gold } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.42, w: "100%", h: 0.08, fill: { color: C.gold } });
  slide.addText(text, { x: 0.4, y: 0.14, w: 12, h: 0.5, fontSize: 11, color: C.midGray, bold: false, fontFace: "Calibri" });
}

function slideTitle(slide, title, subtitle) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.72, w: 0.1, h: 0.55, fill: { color: C.gold } });
  slide.addText(title, { x: 0.35, y: 0.7, w: 12.6, h: 0.6, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri Light", charSpacing: 1 });
  if (subtitle) {
    slide.addText(subtitle, { x: 0.35, y: 1.28, w: 12.6, h: 0.35, fontSize: 14, color: C.gold, fontFace: "Calibri", italic: true });
  }
}

function bullet(text, indent) {
  return { text, options: { bullet: { code: "25A0", indent: indent || 15 }, breakLine: true, color: C.white, fontSize: 15, fontFace: "Calibri" } };
}
function bulletSub(text) {
  return { text, options: { bullet: { code: "25B8", indent: 30 }, breakLine: true, color: C.midGray, fontSize: 13, fontFace: "Calibri" } };
}

// Fetch images as base64
function fetchImgs(urls) {
  try {
    const result = execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`,
      { maxBuffer: 50 * 1024 * 1024, timeout: 60000 }
    );
    return JSON.parse(result.toString());
  } catch (e) {
    console.error("Image fetch error:", e.message);
    return urls.map(() => ({ base64: null, error: e.message }));
  }
}

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  // Gradient strip
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 2.2, fill: { color: C.cardBg } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: "100%", fill: { color: C.red } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.18, w: "100%", h: 0.06, fill: { color: C.gold } });

  s.addText("STABLE vs UNSTABLE", { x: 0.5, y: 0.3, w: 12.3, h: 0.85, fontSize: 48, bold: true, color: C.white, fontFace: "Calibri Light", charSpacing: 3 });
  s.addText("ANGINA PECTORIS", { x: 0.5, y: 1.05, w: 12.3, h: 0.85, fontSize: 48, bold: true, color: C.gold, fontFace: "Calibri Light", charSpacing: 3 });
  s.addText("A Comprehensive Clinical Guide for MBBS Doctors", { x: 0.5, y: 2.4, w: 12.3, h: 0.45, fontSize: 18, color: C.midGray, fontFace: "Calibri", italic: true });
  s.addShape(pres.ShapeType.line, { x: 0.5, y: 3.0, w: 11.8, h: 0, line: { color: C.midGray, width: 0.5, dashType: "dash" } });

  const topics = ["Pathophysiology", "Clinical Features", "ECG Interpretation", "Investigations", "Management", "Case Report"];
  topics.forEach((t, i) => {
    const col = i % 3, row = Math.floor(i / 3);
    s.addShape(pres.ShapeType.rect, {
      x: 0.5 + col * 4.2, y: 3.25 + row * 1.2, w: 3.9, h: 0.9,
      fill: { color: i % 2 === 0 ? C.cardBg : C.cardAlt },
      line: { color: C.teal, width: 1 }
    });
    s.addText(t, { x: 0.55 + col * 4.2, y: 3.28 + row * 1.2, w: 3.8, h: 0.84, fontSize: 16, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  });

  s.addText("Cardiology | Internal Medicine | Department of Medicine", { x: 0.5, y: 6.9, w: 12.3, h: 0.35, fontSize: 11, color: C.midGray, align: "center", fontFace: "Calibri" });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW & CLASSIFICATION: ACS Spectrum
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "CLASSIFICATION OF ISCHEMIC HEART DISEASE");
  slideTitle(s, "The Angina Spectrum", "From stable coronary disease to acute coronary syndrome");

  const imgs = fetchImgs([
    "https://cdn.orris.care/cdss_images/GLGCA_3181896_1763373540517_577b1707-2b4e-4be8-9866-2d88bb29184b.png"
  ]);

  if (imgs[0] && !imgs[0].error) {
    s.addImage({ data: imgs[0].base64, x: 0.4, y: 1.8, w: 12.5, h: 4.9 });
  }

  s.addText("ACS Spectrum: ESC Classification — unstable angina → NSTEMI → STEMI", {
    x: 0.4, y: 6.85, w: 12.5, h: 0.4, fontSize: 10, color: C.midGray, italic: true, fontFace: "Calibri", align: "center"
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — PATHOPHYSIOLOGY COMPARISON
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "PATHOPHYSIOLOGY");
  slideTitle(s, "Pathophysiology: Stable vs Unstable", "Understanding the underlying coronary mechanisms");

  // Left column — stable
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.7, w: 5.8, h: 5.3, fill: { color: C.cardBg }, line: { color: C.teal, width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.7, w: 5.8, h: 0.45, fill: { color: C.teal } });
  s.addText("STABLE ANGINA", { x: 0.3, y: 1.7, w: 5.8, h: 0.45, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  s.addText([
    bullet("Fixed coronary stenosis (≥70%)"),
    bullet("Demand-supply mismatch on exertion"),
    bullet("Intact fibrous cap — plaque is STABLE"),
    bullet("No thrombus formation"),
    bullet("Transient, reversible ischemia"),
    bulletSub("Relieved by rest or nitrates in 2–5 min"),
    bulletSub("O₂ demand exceeds fixed supply"),
    bulletSub("Subendocardial ischemia"),
  ], { x: 0.45, y: 2.2, w: 5.5, h: 4.6, valign: "top", fontFace: "Calibri" });

  // Right column — unstable
  s.addShape(pres.ShapeType.rect, { x: 7.2, y: 1.7, w: 5.8, h: 5.3, fill: { color: "1A0A0A" }, line: { color: C.red, width: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 7.2, y: 1.7, w: 5.8, h: 0.45, fill: { color: C.red } });
  s.addText("UNSTABLE ANGINA", { x: 7.2, y: 1.7, w: 5.8, h: 0.45, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  s.addText([
    bullet("Plaque RUPTURE or EROSION"),
    bullet("Platelet activation & thrombus formation"),
    bullet("Dynamic partial coronary occlusion"),
    bullet("Inflammatory cytokines destabilize cap"),
    bullet("Supply failure — rest pain possible"),
    bulletSub("Thin-cap fibroatheroma (TCFA)"),
    bulletSub("Lipid-rich necrotic core exposed"),
    bulletSub("GP IIb/IIIa activation, fibrin clot"),
  ], { x: 7.35, y: 2.2, w: 5.5, h: 4.6, valign: "top", fontFace: "Calibri" });

  // VS badge
  s.addShape(pres.ShapeType.ellipse, { x: 6.0, y: 3.8, w: 1.3, h: 1.3, fill: { color: C.gold } });
  s.addText("VS", { x: 6.0, y: 3.8, w: 1.3, h: 1.3, fontSize: 22, bold: true, color: C.navy, align: "center", valign: "middle", fontFace: "Calibri" });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — PLAQUE PATHOLOGY (images)
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "PLAQUE PATHOLOGY");
  slideTitle(s, "Coronary Plaque: From Stable to Ruptured", "Gross pathology and OCT imaging of vulnerable plaques");

  const imgs = fetchImgs([
    "https://cdn.orris.care/cdss_images/Pathology_1760051681141_931e45fe-0542-4da5-b8c4-ff161e52b246.jpg",
    "https://cdn.orris.care/cdss_images/Pathology_1760051678678_18220786-12ba-428d-98a0-e5dcf0e16996.jpg",
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_425d9ec038ffe9dbc4c74bb869488fca9f0f0ca5f784163d384dfefeb71c383f.jpg"
  ]);

  const boxes = [
    { x: 0.3, y: 1.75, w: 4.0, h: 4.5, label: "Gross: Atherosclerotic Plaque with Intraplaque Haemorrhage (RCA)" },
    { x: 4.65, y: 1.75, w: 4.0, h: 4.5, label: "Histology: Plaque Rupture + Superimposed Thrombus (EVG stain)" },
    { x: 8.95, y: 1.75, w: 4.0, h: 4.5, label: "OCT + PET/CT: Stable vs Unstable Plaque Metabolic Activity" },
  ];
  boxes.forEach((b, i) => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: C.cardBg }, line: { color: C.midGray, width: 0.5 } });
    if (imgs[i] && !imgs[i].error) {
      s.addImage({ data: imgs[i].base64, x: b.x + 0.1, y: b.y + 0.1, w: b.w - 0.2, h: b.h - 0.6 });
    }
    s.addText(b.label, { x: b.x + 0.05, y: b.y + b.h - 0.55, w: b.w - 0.1, h: 0.5, fontSize: 9, color: C.midGray, align: "center", fontFace: "Calibri", italic: true });
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — CLINICAL FEATURES TABLE
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "CLINICAL FEATURES");
  slideTitle(s, "Clinical Comparison", "Key differentiating features for bedside assessment");

  const rows = [
    ["Feature", "Stable Angina", "Unstable Angina"],
    ["Onset", "Predictable, exertional", "Unpredictable, at rest or minimal exertion"],
    ["Duration", "2–5 minutes", "> 10–20 minutes, or crescendo pattern"],
    ["Precipitants", "Exercise, cold, emotion, meals", "Rest, minimal activity, waking from sleep"],
    ["Relief", "Rest in 2–5 min; GTN works quickly", "GTN may not relieve; rest often insufficient"],
    ["Frequency", "Stable pattern, not worsening", "New-onset, increasing freq/severity (crescendo)"],
    ["Pain character", "Squeezing, pressure, Levine's sign", "Same but more severe or prolonged"],
    ["Radiation", "Arm, jaw, back (typical)", "Same; may be more atypical in women/elderly"],
    ["Dyspnoea", "May accompany chest discomfort", "Anginal equivalent; prominent feature"],
    ["Risk of MI", "Low (chronic stable disease)", "High — medical emergency"],
  ];

  s.addTable(rows, {
    x: 0.3, y: 1.7, w: 12.7, h: 5.4,
    colW: [2.2, 4.5, 6.0],
    border: { type: "solid", color: C.midGray, pt: 0.5 },
    fontSize: 12,
    fontFace: "Calibri",
    color: C.white,
    fill: C.cardBg,
    align: "left",
    valign: "middle",
    rowH: 0.48,
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — ECG FINDINGS
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "ECG INTERPRETATION");
  slideTitle(s, "ECG in Angina", "What to look for on the 12-lead ECG");

  const imgs = fetchImgs([
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0137e9b1dea03ddad942d6c14c4c54048467b194bf6fdfb9c139df7bcd7576d6.jpg",
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_c215fb9417ac543b9a9f45c60351f0c2a5b4f36b1db2efea441f6e07484c05cc.jpg"
  ]);

  // Left — UA ECG
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.75, w: 6.1, h: 5.3, fill: { color: C.cardBg }, line: { color: C.red, width: 1.5 } });
  s.addText("UNSTABLE ANGINA / NSTEMI ECG", { x: 0.3, y: 1.75, w: 6.1, h: 0.4, fontSize: 12, bold: true, color: C.red, align: "center", valign: "middle", fontFace: "Calibri" });
  if (imgs[0] && !imgs[0].error) {
    s.addImage({ data: imgs[0].base64, x: 0.4, y: 2.2, w: 5.9, h: 3.2 });
  }
  s.addText([
    { text: "• ST-segment depression in I, aVL, V4–V6  ", options: { breakLine: true, fontSize: 11, color: C.white } },
    { text: "• Deep T-wave inversions (V3 shown)  ", options: { breakLine: true, fontSize: 11, color: C.white } },
    { text: "• Reciprocal ST elevation in aVR → suggests LMCA/LAD disease  ", options: { breakLine: true, fontSize: 11, color: C.gold } },
    { text: "• ⚠ Troponin NEGATIVE = UA; Positive = NSTEMI  ", options: { breakLine: true, fontSize: 11, color: C.red, bold: true } },
  ], { x: 0.4, y: 5.45, w: 5.9, h: 1.5, valign: "top", fontFace: "Calibri" });

  // Right — serial NSTEMI ECG
  s.addShape(pres.ShapeType.rect, { x: 6.9, y: 1.75, w: 6.1, h: 5.3, fill: { color: C.cardBg }, line: { color: C.teal, width: 1 } });
  s.addText("SERIAL ECG: NSTEMI EVOLUTION", { x: 6.9, y: 1.75, w: 6.1, h: 0.4, fontSize: 12, bold: true, color: C.teal, align: "center", valign: "middle", fontFace: "Calibri" });
  if (imgs[1] && !imgs[1].error) {
    s.addImage({ data: imgs[1].base64, x: 7.0, y: 2.2, w: 5.9, h: 3.2 });
  }
  s.addText([
    { text: "• Serial ECGs a–d showing temporal evolution  ", options: { breakLine: true, fontSize: 11, color: C.white } },
    { text: "• (a) Admission: ST depression V3–V5  ", options: { breakLine: true, fontSize: 11, color: C.white } },
    { text: "• (b,c) After nitrates: progressive improvement  ", options: { breakLine: true, fontSize: 11, color: C.white } },
    { text: "• (d) Pre-discharge: complete ST normalization  ", options: { breakLine: true, fontSize: 11, color: C.gold } },
  ], { x: 7.0, y: 5.45, w: 5.9, h: 1.5, valign: "top", fontFace: "Calibri" });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — ACS CLASSIFICATION DIAGRAM + TROPONIN
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "DIAGNOSIS & BIOMARKERS");
  slideTitle(s, "ACS Classification & Troponin Interpretation", "NSTEMI vs Unstable Angina vs STEMI — key distinctions");

  const imgs = fetchImgs([
    "https://cdn.orris.care/cdss_images/GLGCA_4374545_1766840067128_6f367f94-2114-4c1c-a241-8b1354fb2f77_702752f6-9c27-4ad5-a42c-a8c636a7dfe7.png",
    "https://cdn.orris.care/cdss_images/GLGCA_4715232_1766470703487_b2ad1a7f-0378-43f2-97b7-833912c97f36_d338a972-9dc6-4eb0-8e1d-dc3fdceee7f5.png"
  ]);

  if (imgs[0] && !imgs[0].error) {
    s.addImage({ data: imgs[0].base64, x: 0.3, y: 1.7, w: 6.2, h: 5.5 });
  }
  if (imgs[1] && !imgs[1].error) {
    s.addImage({ data: imgs[1].base64, x: 6.9, y: 1.7, w: 6.1, h: 5.5 });
  }

  s.addText("Source: Management of Acute Coronary Syndromes / Diagnosing and Managing ACS", {
    x: 0.3, y: 7.1, w: 12.7, h: 0.28, fontSize: 9, color: C.midGray, italic: true, align: "center", fontFace: "Calibri"
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — INVESTIGATIONS
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "INVESTIGATIONS");
  slideTitle(s, "Investigations", "A systematic approach from bedside to cathlab");

  const cards = [
    { title: "ECG (12-lead)", color: C.teal, items: ["Stable angina: often NORMAL at rest", "Exercise-induced ST depression ≥1 mm", "UA: ST depression, T-wave inversions", "STEMI: ST elevation ≥2 mm (≥2 leads)"] },
    { title: "Cardiac Biomarkers", color: C.red, items: ["Troponin I/T (high-sensitivity)", "CK-MB (less sensitive, old MI)", "Myoglobin (early, non-specific)", "BNP if heart failure present"] },
    { title: "Stress Testing (Stable)", color: C.gold, items: ["Exercise treadmill test (Bruce protocol)", "+ve: ST depression ≥1 mm at target HR", "Stress echo / nuclear perfusion scan", "CTCA for intermediate pre-test probability"] },
    { title: "Coronary Angiography", color: C.amber, items: ["Gold standard for anatomy", "Stable: elective/semi-urgent", "UA/NSTEMI: within 24–72h (GRACE risk)", "STEMI: primary PCI within 90 min"] },
    { title: "Echocardiography", color: C.midGray, items: ["RWMA during ischemia (wall motion)", "LV function (EF) — prognostic", "Valve disease assessment", "Pericardial effusion exclusion"] },
    { title: "Other Investigations", color: "7B68EE", items: ["FBC, lipid profile, HbA1c, U&E, TFTs", "CXR: cardiomegaly, pulmonary oedema", "CT calcium score (CAC scoring)", "MRI: viability assessment"] },
  ];

  cards.forEach((c, i) => {
    const col = i % 3, row = Math.floor(i / 3);
    const x = 0.3 + col * 4.35, y = 1.75 + row * 2.5;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.1, h: 2.3, fill: { color: C.cardBg }, line: { color: c.color, width: 1.5 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.1, h: 0.4, fill: { color: c.color } });
    s.addText(c.title, { x, y, w: 4.1, h: 0.4, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(c.items.map(i => "▸ " + i).join("\n"), {
      x: x + 0.1, y: y + 0.42, w: 3.9, h: 1.8, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "top"
    });
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — STRESS ECG & ANGIOGRAM images
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "DIAGNOSTIC IMAGING");
  slideTitle(s, "Stress ECG & Coronary Angiography", "Visual demonstration of diagnostic tools in angina");

  const imgs = fetchImgs([
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6067a1b8dea14c1bc52f7c012f494f18c12523301a44da2e9f7d7bfe88bbdd1d.jpg",
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_ce31af7e1d5b9812d343ad0f3ec711e4c4190fe16c47f270a54e90d87419ea09.jpg",
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_665f631326cc9fcad2f1b4124080c8726a374b464bf6200af34eefa7ff653107.jpg"
  ]);

  const panels = [
    { x: 0.3, y: 1.75, w: 4.0, h: 4.2, label: "Positive Stress ECG: ST depression −3.7 mm (inferolateral leads) during treadmill test" },
    { x: 4.65, y: 1.75, w: 4.0, h: 4.2, label: "Coronary Angiogram: LAD stenosis pre-PCI (red arrowhead) → post-stent restoration" },
    { x: 9.0, y: 1.75, w: 4.0, h: 4.2, label: "Coronary Angiogram: Critical RCA stenosis (99%) → successful DES deployment" },
  ];
  panels.forEach((p, i) => {
    s.addShape(pres.ShapeType.rect, { x: p.x, y: p.y, w: p.w, h: p.h, fill: { color: C.cardBg }, line: { color: C.midGray, width: 0.5 } });
    if (imgs[i] && !imgs[i].error) {
      s.addImage({ data: imgs[i].base64, x: p.x + 0.05, y: p.y + 0.05, w: p.w - 0.1, h: p.h - 0.7 });
    }
    s.addText(p.label, { x: p.x + 0.05, y: p.y + p.h - 0.65, w: p.w - 0.1, h: 0.6, fontSize: 9, color: C.midGray, italic: true, fontFace: "Calibri", align: "center" });
  });

  // Key learning point
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 6.05, w: 12.7, h: 0.9, fill: { color: C.cardAlt }, line: { color: C.gold, width: 1 } });
  s.addText("🔑  KEY POINT: For unstable angina/NSTEMI, angiography is performed within 24–72 h based on GRACE score. For STEMI, primary PCI must occur within 90 min of first medical contact.", {
    x: 0.5, y: 6.05, w: 12.5, h: 0.9, fontSize: 12, color: C.gold, bold: false, valign: "middle", fontFace: "Calibri"
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — MANAGEMENT: STABLE ANGINA
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "MANAGEMENT — STABLE ANGINA");
  slideTitle(s, "Management of Stable Angina", "Medical therapy, lifestyle modification, and revascularization");

  // Three pillars
  const pillars = [
    {
      title: "Lifestyle & Risk Factor Modification",
      color: C.teal,
      points: ["Smoking cessation (most impactful single intervention)", "Regular aerobic exercise (30 min, 5×/week)", "Weight reduction & Mediterranean diet", "Strict BP control (<130/80 mmHg)", "Glycaemic control in diabetics (HbA1c <7%)"]
    },
    {
      title: "Pharmacological Therapy",
      color: C.gold,
      points: ["Aspirin 75 mg OD (antiplatelet — primary therapy)", "β-blockers (1st line anti-anginal — atenolol/metoprolol)", "CCBs (if β-blocker contraindicated — amlodipine)", "Long-acting nitrates (isosorbide mononitrate)", "Ranolazine (add-on, late Na⁺ channel inhibitor)", "Statins (atorvastatin 40–80 mg — plaque stabilisation)", "ACE inhibitors/ARBs (if HTN, DM, or LV dysfunction)"]
    },
    {
      title: "Revascularization",
      color: C.amber,
      points: ["PCI (percutaneous coronary intervention) — drug-eluting stent (DES)", "CABG (coronary artery bypass grafting) — 3-vessel or LMCA disease", "Indications: ongoing symptoms despite optimal medical therapy", "Evidence: COURAGE trial — PCI ≈ medical Rx for stable angina", "FFR-guided PCI (fractional flow reserve ≤0.80)"]
    }
  ];

  pillars.forEach((p, i) => {
    const x = 0.3 + i * 4.35;
    s.addShape(pres.ShapeType.rect, { x, y: 1.7, w: 4.1, h: 5.4, fill: { color: C.cardBg }, line: { color: p.color, width: 2 } });
    s.addShape(pres.ShapeType.rect, { x, y: 1.7, w: 4.1, h: 0.5, fill: { color: p.color } });
    s.addText(p.title, { x, y: 1.7, w: 4.1, h: 0.5, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(p.points.map(pt => "▶ " + pt).join("\n"), {
      x: x + 0.12, y: 2.25, w: 3.85, h: 4.7, fontSize: 11.5, color: C.white, fontFace: "Calibri", valign: "top"
    });
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — MANAGEMENT: UNSTABLE ANGINA (ACS)
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "MANAGEMENT — UNSTABLE ANGINA / NSTEMI");
  slideTitle(s, "Acute Management: Unstable Angina/NSTEMI", "MONA + anticoagulation + early invasive strategy");

  // MONA row
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.75, w: 12.7, h: 0.55, fill: { color: "1C0A14" }, line: { color: C.red, width: 1 } });
  s.addText("IMMEDIATE MANAGEMENT  —  MONAB: Morphine · Oxygen · Nitrates · Aspirin · Beta-blocker", {
    x: 0.35, y: 1.75, w: 12.6, h: 0.55, fontSize: 13, bold: true, color: C.red, align: "center", valign: "middle", fontFace: "Calibri"
  });

  const steps = [
    { step: "01", label: "Aspirin + P2Y12", detail: "Aspirin 300 mg stat (loading)\n+ Ticagrelor 180 mg OR Clopidogrel 600 mg\n(DAPT — dual antiplatelet therapy)" },
    { step: "02", label: "Anticoagulation", detail: "Fondaparinux 2.5 mg SC OD (preferred)\nOR LMWH enoxaparin 1 mg/kg BD\nOR UFH IV (if PCI imminent)" },
    { step: "03", label: "Nitrates", detail: "GTN SL (0.5 mg) for immediate relief\nIV GTN infusion if ongoing pain\nAvoid if hypotension (SBP <90)" },
    { step: "04", label: "Beta-Blocker", detail: "IV metoprolol if tachycardic, hypertensive\nOral atenolol/metoprolol when stable\nContraindicated: acute HF, bradycardia" },
    { step: "05", label: "GRACE Score", detail: "Risk stratify ALL patients\nHigh risk: angio within 24 h\nIntermediate: within 72 h\nLow risk: outpatient workup" },
    { step: "06", label: "PCI / CABG", detail: "Early invasive strategy preferred\nDrug-eluting stent (DES) for culprit\nCABG if 3-vessel / LM disease\nContinue DAPT × 12 months post-PCI" },
  ];

  steps.forEach((st, i) => {
    const col = i % 3, row = Math.floor(i / 3);
    const x = 0.3 + col * 4.35, y = 2.4 + row * 2.3;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.1, h: 2.1, fill: { color: C.cardBg }, line: { color: C.red, width: 1 } });
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.1, y: y + 0.1, w: 0.55, h: 0.55, fill: { color: C.red } });
    s.addText(st.step, { x: x + 0.1, y: y + 0.1, w: 0.55, h: 0.55, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(st.label, { x: x + 0.72, y: y + 0.12, w: 3.25, h: 0.45, fontSize: 13, bold: true, color: C.gold, fontFace: "Calibri" });
    s.addText(st.detail, { x: x + 0.15, y: y + 0.62, w: 3.85, h: 1.4, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "top" });
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — PLATELET / THROMBUS MECHANISM + DRUGS
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "ANTITHROMBOTIC PHARMACOLOGY");
  slideTitle(s, "Plaque Rupture → Thrombus → Drug Targets", "Platelet activation cascade and antithrombotic intervention points");

  const imgs = fetchImgs([
    "https://cdn.orris.care/cdss_images/GLGCA_3181896_1763373728336_b7e59e43-62c6-4383-a335-ae27768ae6cb.png"
  ]);

  if (imgs[0] && !imgs[0].error) {
    s.addImage({ data: imgs[0].base64, x: 0.3, y: 1.7, w: 7.5, h: 5.5 });
  }

  // Right side — drug summary boxes
  const drugs = [
    { name: "Antiplatelet Agents", color: C.teal, list: "Aspirin (COX-1 inhibitor → ↓TXA₂)\nClopidogrel / Ticagrelor / Prasugrel (P2Y₁₂)\nAbciximab / Eptifibatide (GPIIb/IIIa)" },
    { name: "Anticoagulants", color: C.amber, list: "Fondaparinux (anti-Xa)\nEnoxaparin LMWH (anti-Xa + IIa)\nUFH (anti-Xa + anti-IIa, reversible)\nBivalirudin (direct thrombin inhibitor)" },
    { name: "Fibrinolytics (STEMI only)", color: C.red, list: "Streptokinase / Alteplase (tPA)\nContraindicated in UA/NSTEMI\nUsed when PCI unavailable ≤12h STEMI" },
  ];
  drugs.forEach((d, i) => {
    const y = 1.7 + i * 1.75;
    s.addShape(pres.ShapeType.rect, { x: 8.1, y, w: 5.0, h: 1.6, fill: { color: C.cardBg }, line: { color: d.color, width: 1.5 } });
    s.addText(d.name, { x: 8.1, y, w: 5.0, h: 0.38, fontSize: 12, bold: true, color: d.color, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(d.list, { x: 8.2, y: y + 0.38, w: 4.8, h: 1.18, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "top" });
  });
  s.addText("Source: Management of Acute Coronary Syndromes (ESC)", { x: 0.3, y: 7.1, w: 12.7, h: 0.28, fontSize: 9, color: C.midGray, italic: true, align: "center", fontFace: "Calibri" });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — CASE REPORT
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "CLINICAL CASE REPORT");
  slideTitle(s, "Case Report: A 58-Year-Old Man with Chest Pain", "Applying clinical knowledge — stable to unstable transition");

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.75, w: 12.7, h: 5.45, fill: { color: C.cardBg }, line: { color: C.gold, width: 1 } });

  // Case sections
  const sections = [
    { title: "PRESENTATION", color: C.gold, text: "Mr. H.S., 58-year-old male, hypertensive, diabetic, smoker (30 pack-years). Known stable exertional chest tightness for 2 years, relieved by rest. Tonight, awoke at 2 AM with severe central chest pressure (8/10), radiation to left arm and jaw. No relief with 3× GTN tablets over 30 min. Diaphoresis, nausea, dyspnoea. BP 158/96, HR 102 bpm, SpO₂ 94% on air." },
    { title: "ECG FINDINGS", color: C.red, text: "12-lead ECG: Sinus tachycardia 102 bpm. ST-segment depression 2–3 mm in leads I, aVL, V4–V6. Deep T-wave inversions in V3–V5. ST elevation in aVR (~1 mm) — suggests proximal LAD or LMCA ischemia. No ST elevation in inferior or precordial leads. Previous ECGs: normal." },
    { title: "INVESTIGATIONS", color: C.teal, text: "Troponin I (0 h): 0.08 ng/mL [↑ — normal <0.04]. Troponin I (3 h): 0.42 ng/mL [rising]. CK-MB: 28 U/L [↑]. eGFR 68, Hb 13.2, INR 1.0. Echo: mild anterior wall hypokinesia, EF 48%. GRACE score: 145 → HIGH RISK. Diagnosis: NSTEMI (was Unstable Angina until troponin returned)." },
    { title: "MANAGEMENT", color: C.amber, text: "• Aspirin 300 mg + Ticagrelor 180 mg STAT\n• Fondaparinux 2.5 mg SC\n• IV GTN infusion; metoprolol 25 mg PO\n• Coronary angiography at 14 h: severe proximal LAD stenosis 95%\n• PCI: DES implanted to proximal LAD — TIMI-3 flow restored\n• Discharge: DAPT + statin + ACEi + beta-blocker\n• 30-day MACE: none; follow-up ETT: negative at 4 weeks" },
  ];

  let y = 1.85;
  sections.forEach((sec, i) => {
    const col = i % 2, row = Math.floor(i / 2);
    const x = 0.4 + col * 6.4;
    const baseY = 1.85 + row * 2.65;
    s.addShape(pres.ShapeType.rect, { x, y: baseY, w: 6.1, h: 2.5, fill: { color: C.cardAlt }, line: { color: sec.color, width: 1.5 } });
    s.addShape(pres.ShapeType.rect, { x, y: baseY, w: 6.1, h: 0.38, fill: { color: sec.color } });
    s.addText(sec.title, { x, y: baseY, w: 6.1, h: 0.38, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(sec.text, { x: x + 0.1, y: baseY + 0.42, w: 5.9, h: 2.0, fontSize: 10.5, color: C.white, fontFace: "Calibri", valign: "top" });
  });
})();

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — SUMMARY COMPARISON TABLE + KEY TAKEAWAYS
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  addBackground(s, C.navy);
  sectionHeader(s, "SUMMARY");
  slideTitle(s, "Key Takeaways", "Stable vs Unstable Angina — Final Summary");

  const rows = [
    ["Parameter", "STABLE ANGINA", "UNSTABLE ANGINA"],
    ["Pathology", "Fixed stenosis, intact plaque", "Plaque rupture + partial thrombus"],
    ["Pain", "Exertional, predictable, <5 min", "Rest pain, crescendo, >10 min, not relieved by GTN"],
    ["ECG (at rest)", "Usually normal", "ST depression / T inversion ± aVR elevation"],
    ["Troponin", "Normal", "Normal (UA) or elevated (NSTEMI)"],
    ["Urgency", "Elective/outpatient", "⚠ Medical emergency — admit & monitor"],
    ["Angiography", "Elective (if medical Rx fails)", "Within 24–72 h (GRACE-guided)"],
    ["First-line Rx", "Aspirin + β-blocker + statin", "DAPT + anticoagulation + early PCI"],
    ["Prognosis", "Good with optimal medical Rx", "High short-term MACE risk without treatment"],
  ];

  s.addTable(rows, {
    x: 0.3, y: 1.7, w: 12.7, h: 4.5,
    colW: [2.8, 4.5, 5.4],
    border: { type: "solid", color: C.midGray, pt: 0.5 },
    fontSize: 12,
    fontFace: "Calibri",
    color: C.white,
    fill: C.cardBg,
    align: "left",
    valign: "middle",
    rowH: 0.44,
  });

  // Bottom takeaway strip
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 6.32, w: 12.7, h: 1.0, fill: { color: "1A1000" }, line: { color: C.gold, width: 1.5 } });
  s.addText([
    { text: "REMEMBER: ", options: { bold: true, color: C.gold, fontSize: 13 } },
    { text: "Any patient with NEW-ONSET angina at rest, crescendo angina, or angina unrelieved by 3 GTN doses must be treated as Unstable Angina (ACS) until proven otherwise. Admit, monitor, DAPT, anticoagulate, and stratify for early invasive strategy.", options: { color: C.white, fontSize: 12 } }
  ], { x: 0.5, y: 6.32, w: 12.5, h: 1.0, valign: "middle", fontFace: "Calibri" });
})();

// Save
pres.writeFile({ fileName: "/home/daytona/workspace/angina-pptx/Stable_vs_Unstable_Angina.pptx" })
  .then(() => console.log("✅ PPTX saved successfully"))
  .catch(e => console.error("Error:", e));