Ecg puri padhni batao

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ECG reading systematic approach Hindi explained

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Bahut achha content mil gaya - Harrison's, Ganong's, aur Braunwald's se ECG ka complete material hai. Ab main ek comprehensive ECG guide Hindi mein likhta hoon:

⚡ ECG Puri Padhna - Systematic Guide

(Source: Harrison's Principles of Internal Medicine 22E, Ganong's Medical Physiology, Braunwald's Heart Disease)

ECG Kya Hai?

ECG (Electrocardiogram) dil ki electrical activity ko body surface par electrodes se record karta hai. Standard 12-lead ECG mein:

6 Limb leads: I, II, III, aVR, aVL, aVF (frontal plane)
6 Chest (Precordial) leads: V1, V2, V3, V4, V5, V6 (horizontal plane)

Yeh diagram dekho - har lead body ke alag angle se dil ko "dekhti" hai:

ECG Paper Samjho - Sabse Pehle

ECG paper par:

Horizontal axis = Time (1 small box = 0.04 sec, 1 large box = 0.2 sec)
Vertical axis = Voltage/Amplitude (1 small box = 0.1 mV, 1 large box = 0.5 mV)
Standard speed = 25 mm/sec
Standard calibration = 10 mm = 1 mV

SYSTEMATIC APPROACH - 14 Steps (Harrison's)

Harrison's ke mutabik har ECG mein yeh 14 cheezein systematic taur par check karo:

Standardization & Technical features

Rhythm

Heart Rate

PR Interval / AV Conduction

QRS Interval

QT/QTc Interval

Mean QRS Electrical Axis

P Waves

QRS Voltages

Precordial R-wave Progression

Abnormal Q Waves

ST Segments

T Waves

U Waves

STEP-BY-STEP BREAKDOWN

1. Standardization Check (Calibration)

Har ECG ke shuru mein ek calibration pulse honi chahiye: 10 mm tall, 0.2 sec wide
Agar yeh missing hai ya galat hai → ECG unreliable hai

2. RHYTHM

Sinus Rhythm ki Pehchan:

Har QRS se pehle ek P wave honi chahiye
P wave Lead II mein positive (upright), aVR mein negative honi chahiye
P-P interval regular hona chahiye
HR: 60-100 bpm

Rhythm	Feature
Normal Sinus	P wave → QRS, regular, 60-100 bpm
Sinus Brady	Wohi par rate <60
Sinus Tachy	Wohi par rate >100
AF	P waves absent, irregular irregular
Atrial Flutter	Sawtooth P waves, 300/min

3. HEART RATE Calculate Karo

Method 1 - Regular Rhythm:

300 ÷ number of large boxes between two R waves
Example: 2 large boxes = 300/2 = 150 bpm
Shortcut: 300 → 150 → 100 → 75 → 60 → 50 (yaad karo!)

Method 2 - Irregular Rhythm:

Count karein kitne QRS complexes hain 10-second strip mein
Multiply by 6 = HR per minute

4. P WAVE

Normal P wave:

Duration: <120 ms (3 small boxes)
Amplitude: <2.5 mm (2.5 small boxes)
Lead II mein positive (upright)
aVR mein negative
V1 mein biphasic (positive + small negative component) ho sakta hai

Abnormalities:

P tall (>2.5mm) aur pointed → Right Atrial Enlargement (P-pulmonale)
P broad (>120ms), notched → Left Atrial Enlargement (P-mitrale)

5. PR INTERVAL

Measure: P wave ke shuru se QRS ke shuru tak
Normal: 120-200 ms (3-5 small boxes)

PR	Matlab
<120 ms	Pre-excitation (WPW) ya junctional rhythm
>200 ms	1st Degree AV Block
Progressive lengthening	2nd Degree AV Block (Wenckebach/Mobitz I)
Fixed PR + dropped QRS	2nd Degree AV Block (Mobitz II)
No relation P to QRS	Complete (3rd Degree) AV Block

6. QRS COMPLEX

Normal QRS:

Duration: <120 ms (3 small boxes)
V1 mein: Small r + large S (rS pattern)
V6 mein: Small q + large R + small s (qRs pattern)

R-wave Progression:

V1 se V6 tak R wave progressively barhti hai
Transition zone (jahan R=S): usually V3 ya V4
Agar V1-V4 mein R nahi badh raha → Poor R-wave progression (anterior MI ka sign)

QRS Width:

120 ms → Bundle Branch Block (BBB)
- RBBB: V1 mein RSR' (rabbit ears), V6 mein wide S wave
- LBBB: V6 mein broad R, V1 mein QS/rS pattern

Abnormal Q waves:

40 ms wide (1 small box) ya >25% of QRS height → Pathological Q wave (old MI ka sign)

7. QRS AXIS (Electrical Axis)

Einthoven triangle ke principle par based:

Normal Axis: -30° to +100°

Quick Method - Lead I + Lead aVF dekho:

Lead I	aVF	Axis
Positive	Positive	Normal (-30° to +90°)
Positive	Negative	Left Axis Deviation (LAD)
Negative	Positive	Right Axis Deviation (RAD)
Negative	Negative	Extreme / Northwest Axis

Causes:

LAD (<-30°): LVH, Left anterior fascicular block (LAFB), Inferior MI
RAD (>+100°): RVH, Left posterior fascicular block, Lateral MI, WPW, Dextrocardia

8. ST SEGMENT

Baseline (isoelectric) pe honi chahiye - J point ke baad se T wave tak
Normal: Isoelectric ± 0.5 mm

ST Elevation (STEMI signs):

≥1 mm in limb leads, ≥2 mm in precordial leads
Convex (dome shape) - suggests acute infarction
Concave (saddle shape) - suggests pericarditis

ST Depression:

Subendocardial ischemia
Digoxin effect (scooping)
Reciprocal changes in STEMI

9. T WAVE

Normal T wave:

Same direction as QRS (concordant)
Slightly asymmetric - slow rise, fast fall
V1 mein negative ya flat
aVR mein negative

Abnormalities:

Tall peaked T waves → Hyperkalemia, hyperacute STEMI
Inverted T waves → Ischemia, RVH (V1-V3), LVH (V5-V6)
Wellens' pattern (deep T inversion V1-V4) → Critical LAD stenosis - Emergency!

10. QT INTERVAL

QRS ke shuru se T wave ke end tak
Normal QTc (corrected): ≤440 ms men, ≤460 ms women
Bazett's formula: QTc = QT / √(RR interval in seconds)
Prolonged QT → Torsades de Pointes ka risk (hypokalemia, drugs, congenital)
Short QT → Hypercalcemia, digoxin toxicity

11. U WAVE

T wave ke baad ek chhoti si wave
Normally <1 mm, same direction as T wave
Prominent U wave → Hypokalemia (most common cause), amiodarone, sotalol

NORMAL INTERVALS - Quick Reference Table

Parameter	Normal Value
Heart Rate	60-100 bpm
PR Interval	120-200 ms (3-5 small boxes)
QRS Duration	<120 ms (<3 small boxes)
QT Interval (QTc)	<440 ms (men), <460 ms (women)
QRS Axis	-30° to +100°
P wave amplitude	<2.5 mm
P wave duration	<120 ms

LEADS KA LOCATION - Kaunsa Lead Kya Dekh Raha Hai

Leads	Dil Ka Hissa
II, III, aVF	Inferior wall (RCA territory)
I, aVL, V5-V6	Lateral wall (LCx territory)
V1-V4	Anterior wall (LAD territory)
V1-V2	Septal
aVR	Right atrium / aortic root
V4R	Right ventricle (special lead)

ECG PADHNE KA MEMORY TRICK

"Rate Rhythm Axis P-wave PR-QRS-ST-T-U"

Ya phir: "Real Radiologists Are Pretty Poor At Studying, Till U nag"

Rate
Rhythm
Axis
P wave
PR interval
QRS
ST segment
T wave
U wave

COMMON PATTERNS - Quick Diagnosis

Pattern	Kya Socho
Diffuse ST elevation + PR depression	Acute Pericarditis
STEMI + reciprocal changes	Acute MI
Delta wave + short PR	WPW Syndrome
Tall R in V1 + RAD	RVH / RBBB / Posterior MI
Peaked P in II + RAD	Cor Pulmonale
Electrical alternans	Cardiac Tamponade
Sine wave pattern	Severe Hyperkalemia
Osborne (J) wave	Hypothermia
"S1Q3T3"	Pulmonary Embolism

Sources: Harrison's Principles of Internal Medicine 22E (2025) - Ch. 247 | Ganong's Review of Medical Physiology 26E | Braunwald's Heart Disease

ECG ek skill hai - jitni practice karoge utna better hoga. ECG Wave-Maven (Harvard) par free practice cases milte hain.

Create a quick reference PDF for ECG normal values and diagnostic criteria

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace not found"

Running Command

mkdir -p /home/daytona/workspace/ecg-pdf

Writing File

~/ecg-pdf/create_ecg_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.pdfgen import canvas
from reportlab.graphics.shapes import Drawing, Rect, Line, String, Circle
from reportlab.graphics import renderPDF
import os

OUTPUT_PATH = "/home/daytona/workspace/ecg-pdf/ECG_Quick_Reference.pdf"

# ── Color Palette ──────────────────────────────────────────────────────────────
C_RED       = colors.HexColor("#C0392B")
C_DARK      = colors.HexColor("#1A1A2E")
C_BLUE      = colors.HexColor("#1565C0")
C_TEAL      = colors.HexColor("#00695C")
C_ORANGE    = colors.HexColor("#E65100")
C_PURPLE    = colors.HexColor("#6A1B9A")
C_BG_LIGHT  = colors.HexColor("#F5F5F5")
C_BG_RED    = colors.HexColor("#FFEBEE")
C_BG_BLUE   = colors.HexColor("#E3F2FD")
C_BG_TEAL   = colors.HexColor("#E0F2F1")
C_BG_ORANGE = colors.HexColor("#FFF3E0")
C_BG_PURPLE = colors.HexColor("#F3E5F5")
C_BG_GREEN  = colors.HexColor("#E8F5E9")
C_HEADER_BG = colors.HexColor("#B71C1C")
C_WHITE     = colors.white
C_GRAY      = colors.HexColor("#757575")
C_LGRAY     = colors.HexColor("#EEEEEE")
C_YELLOW    = colors.HexColor("#FFF176")

# ── Page Layout ────────────────────────────────────────────────────────────────
PAGE_W, PAGE_H = A4
MARGIN = 14 * mm

# ── Styles ─────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

TITLE_STYLE = S("MainTitle",
    fontName="Helvetica-Bold", fontSize=22, textColor=C_WHITE,
    alignment=TA_CENTER, spaceAfter=0, leading=26)

SUBTITLE_STYLE = S("SubTitle",
    fontName="Helvetica", fontSize=11, textColor=colors.HexColor("#FFCDD2"),
    alignment=TA_CENTER, spaceAfter=0, leading=14)

SEC_HEADER = S("SectionHeader",
    fontName="Helvetica-Bold", fontSize=9.5, textColor=C_WHITE,
    alignment=TA_LEFT, leading=12, leftIndent=3)

CELL_BOLD = S("CellBold",
    fontName="Helvetica-Bold", fontSize=8.2, textColor=C_DARK,
    alignment=TA_LEFT, leading=10)

CELL_NORMAL = S("CellNormal",
    fontName="Helvetica", fontSize=8.0, textColor=C_DARK,
    alignment=TA_LEFT, leading=10)

CELL_GREEN = S("CellGreen",
    fontName="Helvetica-Bold", fontSize=8.2, textColor=C_TEAL,
    alignment=TA_LEFT, leading=10)

CELL_RED = S("CellRed",
    fontName="Helvetica-Bold", fontSize=8.2, textColor=C_RED,
    alignment=TA_LEFT, leading=10)

CELL_CENTER = S("CellCenter",
    fontName="Helvetica", fontSize=8.0, textColor=C_DARK,
    alignment=TA_CENTER, leading=10)

CELL_BOLD_CENTER = S("CellBoldCenter",
    fontName="Helvetica-Bold", fontSize=8.2, textColor=C_DARK,
    alignment=TA_CENTER, leading=10)

TINY = S("Tiny",
    fontName="Helvetica", fontSize=7.0, textColor=C_GRAY,
    alignment=TA_CENTER, leading=9)

FOOTER_STYLE = S("Footer",
    fontName="Helvetica-Oblique", fontSize=7.0, textColor=C_GRAY,
    alignment=TA_CENTER, leading=9)

# ── Table style helper ─────────────────────────────────────────────────────────
def base_ts(header_bg=C_BLUE, header_fg=C_WHITE):
    return TableStyle([
        ('BACKGROUND',   (0, 0), (-1, 0), header_bg),
        ('TEXTCOLOR',    (0, 0), (-1, 0), header_fg),
        ('FONTNAME',     (0, 0), (-1, 0), 'Helvetica-Bold'),
        ('FONTSIZE',     (0, 0), (-1, 0), 8.5),
        ('ALIGN',        (0, 0), (-1, -1), 'LEFT'),
        ('VALIGN',       (0, 0), (-1, -1), 'MIDDLE'),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [C_WHITE, C_BG_LIGHT]),
        ('GRID',         (0, 0), (-1, -1), 0.4, colors.HexColor("#BDBDBD")),
        ('TOPPADDING',   (0, 0), (-1, -1), 3),
        ('BOTTOMPADDING',(0, 0), (-1, -1), 3),
        ('LEFTPADDING',  (0, 0), (-1, -1), 5),
        ('RIGHTPADDING', (0, 0), (-1, -1), 5),
    ])

def section_label(text, bg=C_BLUE):
    """Returns a single-cell table used as a section header bar."""
    t = Table([[Paragraph(text, SEC_HEADER)]], colWidths=[PAGE_W - 2*MARGIN])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('TOPPADDING', (0,0), (-1,-1), 4),
        ('BOTTOMPADDING', (0,0), (-1,-1), 4),
        ('LEFTPADDING', (0,0), (-1,-1), 6),
        ('RIGHTPADDING', (0,0), (-1,-1), 6),
        ('ROUNDEDCORNERS', [3, 3, 3, 3]),
    ]))
    return t

# ══════════════════════════════════════════════════════════════════════════════
# PAGE 1 – Normal Values + Lead Anatomy + Rate Calculation
# ══════════════════════════════════════════════════════════════════════════════

def build_page1():
    story = []
    W = PAGE_W - 2*MARGIN

    # ── HEADER BANNER ──────────────────────────────────────────────────────────
    header_table = Table(
        [[Paragraph("ECG Quick Reference Guide", TITLE_STYLE)],
         [Paragraph("Normal Values  •  Diagnostic Criteria  •  Systematic Interpretation", SUBTITLE_STYLE)]],
        colWidths=[W]
    )
    header_table.setStyle(TableStyle([
        ('BACKGROUND',    (0,0), (-1,-1), C_HEADER_BG),
        ('TOPPADDING',    (0,0), (-1,-1), 10),
        ('BOTTOMPADDING', (0,0), (-1,-1), 10),
        ('LEFTPADDING',   (0,0), (-1,-1), 8),
        ('RIGHTPADDING',  (0,0), (-1,-1), 8),
        ('ROUNDEDCORNERS',[4,4,4,4]),
    ]))
    story.append(header_table)
    story.append(Spacer(1, 5*mm))

    # ── ECG PAPER BASICS ──────────────────────────────────────────────────────
    story.append(section_label("📋  ECG PAPER BASICS", C_DARK))
    story.append(Spacer(1, 2*mm))

    basics_data = [
        [Paragraph("Parameter", CELL_BOLD_CENTER), Paragraph("Value", CELL_BOLD_CENTER),
         Paragraph("Parameter", CELL_BOLD_CENTER), Paragraph("Value", CELL_BOLD_CENTER)],
        [Paragraph("Paper speed", CELL_BOLD), Paragraph("25 mm/sec", CELL_GREEN),
         Paragraph("1 small box (horiz)", CELL_BOLD), Paragraph("0.04 sec  /  1 mm", CELL_NORMAL)],
        [Paragraph("Standard gain", CELL_BOLD), Paragraph("10 mm = 1 mV", CELL_GREEN),
         Paragraph("1 large box (horiz)", CELL_BOLD), Paragraph("0.20 sec  /  5 mm", CELL_NORMAL)],
        [Paragraph("1 small box (vert)", CELL_BOLD), Paragraph("0.1 mV", CELL_NORMAL),
         Paragraph("1 large box (vert)", CELL_BOLD), Paragraph("0.5 mV", CELL_NORMAL)],
    ]
    col_w = W / 4
    basics_t = Table(basics_data, colWidths=[col_w]*4)
    ts = base_ts(header_bg=C_DARK)
    ts.add('BACKGROUND', (0,0), (-1,0), C_DARK)
    basics_t.setStyle(ts)
    story.append(basics_t)
    story.append(Spacer(1, 4*mm))

    # ── NORMAL INTERVALS TABLE ─────────────────────────────────────────────────
    story.append(section_label("⏱  NORMAL ECG INTERVALS & AMPLITUDES", C_BLUE))
    story.append(Spacer(1, 2*mm))

    intervals_data = [
        [Paragraph("Wave / Interval", CELL_BOLD), Paragraph("Normal Range", CELL_BOLD),
         Paragraph("Boxes", CELL_BOLD), Paragraph("Clinical Note", CELL_BOLD)],
        [Paragraph("Heart Rate", CELL_BOLD),        Paragraph("60 – 100 bpm", CELL_GREEN),
         Paragraph("—", CELL_CENTER),               Paragraph("Sinus bradycardia <60, tachycardia >100", CELL_NORMAL)],
        [Paragraph("P wave duration", CELL_BOLD),   Paragraph("< 120 ms", CELL_GREEN),
         Paragraph("< 3 small", CELL_CENTER),        Paragraph(">120 ms notched = Left atrial enlargement", CELL_NORMAL)],
        [Paragraph("P wave amplitude", CELL_BOLD),  Paragraph("< 2.5 mm", CELL_GREEN),
         Paragraph("< 2.5 small", CELL_CENTER),      Paragraph(">2.5 mm peaked = Right atrial enlargement", CELL_NORMAL)],
        [Paragraph("PR interval", CELL_BOLD),        Paragraph("120 – 200 ms", CELL_GREEN),
         Paragraph("3 – 5 large", CELL_CENTER),      Paragraph("<120 WPW/junctional; >200 1st-degree AV block", CELL_NORMAL)],
        [Paragraph("QRS duration", CELL_BOLD),       Paragraph("< 120 ms", CELL_GREEN),
         Paragraph("< 3 small", CELL_CENTER),         Paragraph(">120 ms = Bundle Branch Block", CELL_NORMAL)],
        [Paragraph("QT interval (QTc)", CELL_BOLD),  Paragraph("Male <440 ms\nFemale <460 ms", CELL_GREEN),
         Paragraph("—", CELL_CENTER),                Paragraph("Bazett: QTc = QT / sqrt(RR in sec)", CELL_NORMAL)],
        [Paragraph("QRS Axis", CELL_BOLD),           Paragraph("-30° to +100°", CELL_GREEN),
         Paragraph("—", CELL_CENTER),                Paragraph("LAD < -30°;  RAD > +100°", CELL_NORMAL)],
        [Paragraph("R-wave progression", CELL_BOLD), Paragraph("V1 → V6 increasing", CELL_GREEN),
         Paragraph("—", CELL_CENTER),                Paragraph("Transition (R=S) normally at V3/V4", CELL_NORMAL)],
        [Paragraph("U wave", CELL_BOLD),             Paragraph("< 1 mm", CELL_GREEN),
         Paragraph("< 1 small", CELL_CENTER),         Paragraph("Prominent U = hypokalemia, amiodarone", CELL_NORMAL)],
    ]
    cw = [W*0.19, W*0.18, W*0.13, W*0.50]
    iv_t = Table(intervals_data, colWidths=cw)
    ts2 = base_ts(header_bg=C_BLUE)
    ts2.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_BLUE])
    iv_t.setStyle(ts2)
    story.append(iv_t)
    story.append(Spacer(1, 4*mm))

    # ── TWO-COLUMN ROW: Leads Anatomy + Heart Rate ─────────────────────────────
    story.append(section_label("🗺  LEAD TERRITORIES & CULPRIT VESSELS", C_TEAL))
    story.append(Spacer(1, 2*mm))

    lead_data = [
        [Paragraph("Leads", CELL_BOLD_CENTER), Paragraph("Wall", CELL_BOLD_CENTER), Paragraph("Artery", CELL_BOLD_CENTER)],
        [Paragraph("II, III, aVF", CELL_BOLD),    Paragraph("Inferior", CELL_NORMAL),          Paragraph("RCA", CELL_NORMAL)],
        [Paragraph("V1 – V4", CELL_BOLD),         Paragraph("Anterior", CELL_NORMAL),          Paragraph("LAD", CELL_NORMAL)],
        [Paragraph("V1 – V2", CELL_BOLD),         Paragraph("Septal", CELL_NORMAL),            Paragraph("LAD (septal perfs)", CELL_NORMAL)],
        [Paragraph("I, aVL, V5–V6", CELL_BOLD),  Paragraph("Lateral", CELL_NORMAL),           Paragraph("LCx", CELL_NORMAL)],
        [Paragraph("V1–V2 tall R", CELL_BOLD),    Paragraph("Posterior", CELL_NORMAL),         Paragraph("RCA / LCx", CELL_NORMAL)],
        [Paragraph("V4R", CELL_BOLD),             Paragraph("Right ventricle", CELL_NORMAL),   Paragraph("RCA (proximal)", CELL_NORMAL)],
        [Paragraph("aVR", CELL_BOLD),             Paragraph("RV outflow/aortic root", CELL_NORMAL), Paragraph("LMCA / LAD", CELL_NORMAL)],
    ]
    lead_t = Table(lead_data, colWidths=[W*0.3*0.35, W*0.3*0.35, W*0.3*0.30])
    ts3 = base_ts(header_bg=C_TEAL)
    ts3.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_TEAL])
    lead_t.setStyle(ts3)

    # Heart Rate Quick Calc
    hr_data = [
        [Paragraph("HEART RATE QUICK CALCULATION", CELL_BOLD_CENTER)],
        [Paragraph("<b>Regular rhythm:</b>  300 ÷ (large boxes between R-R)", CELL_NORMAL)],
        [Paragraph("<b>Mnemonic ladder:</b>  1 box=300  |  2=150  |  3=100\n4=75  |  5=60  |  6=50  |  7=43", CELL_NORMAL)],
        [Paragraph("<b>Irregular rhythm:</b>  Count QRS in 10-sec strip × 6", CELL_NORMAL)],
        [Paragraph("<b>300-method tip:</b>  Find an R on a heavy line, count boxes to next R", CELL_NORMAL)],
    ]
    hr_t = Table(hr_data, colWidths=[W*0.68])
    hr_t.setStyle(TableStyle([
        ('BACKGROUND',    (0,0), (-1,0), C_ORANGE),
        ('TEXTCOLOR',     (0,0), (-1,0), C_WHITE),
        ('FONTNAME',      (0,0), (-1,0), 'Helvetica-Bold'),
        ('GRID',          (0,0), (-1,-1), 0.4, colors.HexColor("#BDBDBD")),
        ('ROWBACKGROUNDS',(0,1), (-1,-1), [C_BG_ORANGE, C_WHITE]),
        ('TOPPADDING',    (0,0), (-1,-1), 4),
        ('BOTTOMPADDING', (0,0), (-1,-1), 4),
        ('LEFTPADDING',   (0,0), (-1,-1), 6),
        ('RIGHTPADDING',  (0,0), (-1,-1), 6),
    ]))

    two_col = Table(
        [[lead_t, Spacer(3*mm, 1), hr_t]],
        colWidths=[W*0.30, 3*mm, W*0.68]
    )
    two_col.setStyle(TableStyle([
        ('VALIGN', (0,0), (-1,-1), 'TOP'),
        ('LEFTPADDING', (0,0), (-1,-1), 0),
        ('RIGHTPADDING', (0,0), (-1,-1), 0),
        ('TOPPADDING', (0,0), (-1,-1), 0),
        ('BOTTOMPADDING', (0,0), (-1,-1), 0),
    ]))
    story.append(two_col)
    story.append(Spacer(1, 4*mm))

    # ── SOURCE FOOTER ──────────────────────────────────────────────────────────
    story.append(HRFlowable(width=W, thickness=0.5, color=C_GRAY))
    story.append(Spacer(1, 1*mm))
    story.append(Paragraph(
        "Sources: Harrison's Principles of Internal Medicine 22E (2025) | Ganong's Review of Medical Physiology 26E | Braunwald's Heart Disease 12E     •     Page 1 of 2",
        FOOTER_STYLE))

    return story

# ══════════════════════════════════════════════════════════════════════════════
# PAGE 2 – Diagnostic Criteria
# ══════════════════════════════════════════════════════════════════════════════

def build_page2():
    story = []
    W = PAGE_W - 2*MARGIN

    # Mini header
    mini_h = Table([[Paragraph("ECG Diagnostic Criteria  —  Quick Reference", TITLE_STYLE)]],
                   colWidths=[W])
    mini_h.setStyle(TableStyle([
        ('BACKGROUND',    (0,0), (-1,-1), C_HEADER_BG),
        ('TOPPADDING',    (0,0), (-1,-1), 8),
        ('BOTTOMPADDING', (0,0), (-1,-1), 8),
        ('LEFTPADDING',   (0,0), (-1,-1), 8),
        ('RIGHTPADDING',  (0,0), (-1,-1), 8),
        ('ROUNDEDCORNERS',[4,4,4,4]),
    ]))
    story.append(mini_h)
    story.append(Spacer(1, 4*mm))

    # ── AV BLOCKS ─────────────────────────────────────────────────────────────
    story.append(section_label("💔  AV CONDUCTION BLOCKS", C_RED))
    story.append(Spacer(1, 2*mm))

    av_data = [
        [Paragraph("Block Type", CELL_BOLD), Paragraph("PR Interval", CELL_BOLD),
         Paragraph("Dropped QRS?", CELL_BOLD), Paragraph("P:QRS Ratio", CELL_BOLD), Paragraph("Key Feature", CELL_BOLD)],
        [Paragraph("1st Degree", CELL_NORMAL),        Paragraph(">200 ms  (fixed)", CELL_RED),
         Paragraph("No", CELL_NORMAL),                Paragraph("1:1", CELL_CENTER),
         Paragraph("Prolonged but all conduct", CELL_NORMAL)],
        [Paragraph("2nd Degree – Mobitz I\n(Wenckebach)", CELL_NORMAL),  Paragraph("Progressive lengthening", CELL_RED),
         Paragraph("Yes (periodic)", CELL_NORMAL),    Paragraph(">1:1", CELL_CENTER),
         Paragraph("Grouped beating; PR lengthens until drop", CELL_NORMAL)],
        [Paragraph("2nd Degree – Mobitz II", CELL_NORMAL), Paragraph("Fixed PR", CELL_RED),
         Paragraph("Yes (sudden)", CELL_NORMAL),      Paragraph(">1:1", CELL_CENTER),
         Paragraph("Sudden non-conducted P; often needs pacemaker", CELL_NORMAL)],
        [Paragraph("3rd Degree (Complete)", CELL_BOLD), Paragraph("No relation (dissociation)", CELL_RED),
         Paragraph("P & QRS independent", CELL_NORMAL), Paragraph("None", CELL_CENTER),
         Paragraph("P rate > QRS rate; escape rhythm present", CELL_NORMAL)],
    ]
    cw_av = [W*0.20, W*0.18, W*0.14, W*0.12, W*0.36]
    av_t = Table(av_data, colWidths=cw_av)
    ts_av = base_ts(header_bg=C_RED)
    ts_av.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_RED])
    av_t.setStyle(ts_av)
    story.append(av_t)
    story.append(Spacer(1, 4*mm))

    # ── BUNDLE BRANCH BLOCKS ──────────────────────────────────────────────────
    story.append(section_label("🔀  BUNDLE BRANCH BLOCKS  (QRS > 120 ms)", C_PURPLE))
    story.append(Spacer(1, 2*mm))

    bbb_data = [
        [Paragraph("Feature", CELL_BOLD), Paragraph("RBBB", CELL_BOLD), Paragraph("LBBB", CELL_BOLD)],
        [Paragraph("V1 pattern", CELL_BOLD),      Paragraph("RSR' (rabbit ears) / rSR'", CELL_NORMAL),    Paragraph("QS or rS (broad notched)", CELL_NORMAL)],
        [Paragraph("V6 pattern", CELL_BOLD),      Paragraph("Wide slurred S wave", CELL_NORMAL),          Paragraph("Broad monophasic R (no Q/S)", CELL_NORMAL)],
        [Paragraph("Lead I", CELL_BOLD),          Paragraph("Wide S wave", CELL_NORMAL),                  Paragraph("Broad R, no Q", CELL_NORMAL)],
        [Paragraph("ST-T changes", CELL_BOLD),    Paragraph("Discordant to QRS terminal", CELL_NORMAL),   Paragraph("Discordant to QRS (ST opp. to R)", CELL_NORMAL)],
        [Paragraph("Sgarbossa criteria", CELL_BOLD), Paragraph("Not typically applied", CELL_NORMAL),     Paragraph("Used to detect MI in LBBB", CELL_NORMAL)],
    ]
    cw_bbb = [W*0.22, W*0.39, W*0.39]
    bbb_t = Table(bbb_data, colWidths=cw_bbb)
    ts_bbb = base_ts(header_bg=C_PURPLE)
    ts_bbb.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_PURPLE])
    bbb_t.setStyle(ts_bbb)
    story.append(bbb_t)
    story.append(Spacer(1, 4*mm))

    # ── TWO-COLUMN: Axis + Hypertrophy ─────────────────────────────────────────
    col_left_w = W * 0.46
    col_right_w = W * 0.50
    gap = W * 0.04

    # LEFT: QRS Axis
    story.append(section_label("🧭  QRS AXIS  (Frontal Plane)", C_TEAL))
    story.append(Spacer(1, 2*mm))

    axis_data = [
        [Paragraph("Lead I", CELL_BOLD_CENTER), Paragraph("aVF", CELL_BOLD_CENTER),
         Paragraph("Axis", CELL_BOLD_CENTER),   Paragraph("Causes", CELL_BOLD)],
        [Paragraph("Positive (+)", CELL_CENTER), Paragraph("Positive (+)", CELL_CENTER),
         Paragraph("NORMAL\n(-30 to +90)", CELL_GREEN), Paragraph("Normal", CELL_NORMAL)],
        [Paragraph("Positive (+)", CELL_CENTER), Paragraph("Negative (-)", CELL_CENTER),
         Paragraph("LAD\n(< -30°)", CELL_RED),  Paragraph("LVH, LAFB, inferior MI", CELL_NORMAL)],
        [Paragraph("Negative (-)", CELL_CENTER), Paragraph("Positive (+)", CELL_CENTER),
         Paragraph("RAD\n(> +100°)", CELL_RED), Paragraph("RVH, LPFB, lateral MI, PE", CELL_NORMAL)],
        [Paragraph("Negative (-)", CELL_CENTER), Paragraph("Negative (-)", CELL_CENTER),
         Paragraph("EXTREME\n(NW axis)", CELL_RED), Paragraph("Severe RVH, dextrocardia, artifact", CELL_NORMAL)],
    ]
    cw_axis = [col_left_w*0.22, col_left_w*0.22, col_left_w*0.22, col_left_w*0.34]
    axis_t = Table(axis_data, colWidths=cw_axis)
    ts_axis = base_ts(header_bg=C_TEAL)
    ts_axis.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_TEAL])
    axis_t.setStyle(ts_axis)

    # RIGHT: Hypertrophy Criteria
    hyp_data = [
        [Paragraph("Hypertrophy Criteria", CELL_BOLD_CENTER), Paragraph("Criterion", CELL_BOLD_CENTER)],
        [Paragraph("LVH – Sokolow-Lyon", CELL_BOLD), Paragraph("S(V1) + R(V5 or V6) > 35 mm", CELL_NORMAL)],
        [Paragraph("LVH – Cornell (men)", CELL_BOLD),   Paragraph("R(aVL) + S(V3) > 28 mm", CELL_NORMAL)],
        [Paragraph("LVH – Cornell (women)", CELL_BOLD), Paragraph("R(aVL) + S(V3) > 20 mm", CELL_NORMAL)],
        [Paragraph("LVH – aVL alone", CELL_BOLD),       Paragraph("R(aVL) > 11 mm", CELL_NORMAL)],
        [Paragraph("RVH criteria", CELL_BOLD), Paragraph("R>S in V1, RAD, R(V1)+S(V5/6)>11mm", CELL_NORMAL)],
        [Paragraph("LAE (P-mitrale)", CELL_BOLD), Paragraph("P duration >120ms or biphasic in V1", CELL_NORMAL)],
        [Paragraph("RAE (P-pulmonale)", CELL_BOLD), Paragraph("P amplitude >2.5mm in II, III, aVF", CELL_NORMAL)],
    ]
    cw_hyp = [col_right_w*0.45, col_right_w*0.55]
    hyp_t = Table(hyp_data, colWidths=cw_hyp)
    ts_hyp = base_ts(header_bg=C_ORANGE)
    ts_hyp.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_ORANGE])
    hyp_t.setStyle(ts_hyp)

    two_col2 = Table(
        [[axis_t, Spacer(gap, 1), hyp_t]],
        colWidths=[col_left_w, gap, col_right_w]
    )
    two_col2.setStyle(TableStyle([
        ('VALIGN', (0,0), (-1,-1), 'TOP'),
        ('LEFTPADDING', (0,0), (-1,-1), 0),
        ('RIGHTPADDING', (0,0), (-1,-1), 0),
        ('TOPPADDING', (0,0), (-1,-1), 0),
        ('BOTTOMPADDING', (0,0), (-1,-1), 0),
    ]))
    story.append(two_col2)
    story.append(Spacer(1, 4*mm))

    # ── CLASSIC ECG PATTERNS ──────────────────────────────────────────────────
    story.append(section_label("🔍  CLASSIC / HIGH-YIELD ECG PATTERNS", C_DARK))
    story.append(Spacer(1, 2*mm))

    pat_data = [
        [Paragraph("Pattern", CELL_BOLD), Paragraph("ECG Finding", CELL_BOLD), Paragraph("Diagnosis", CELL_BOLD)],
        [Paragraph("Saddle-shaped ST elevation + PR depression", CELL_NORMAL), Paragraph("Diffuse concave STE + PR depression in I,II,V2-6", CELL_NORMAL), Paragraph("Acute Pericarditis", CELL_BOLD)],
        [Paragraph("Electrical alternans", CELL_NORMAL), Paragraph("Alternating QRS height beat-to-beat", CELL_NORMAL), Paragraph("Cardiac Tamponade", CELL_BOLD)],
        [Paragraph("Delta wave + short PR (<120ms)", CELL_NORMAL), Paragraph("Slurred upstroke of QRS, short PR, wide QRS", CELL_NORMAL), Paragraph("WPW Syndrome", CELL_BOLD)],
        [Paragraph("S1Q3T3", CELL_NORMAL), Paragraph("S in I, Q in III, T inversion in III", CELL_NORMAL), Paragraph("Pulmonary Embolism (non-specific)", CELL_BOLD)],
        [Paragraph("Osborne (J) waves", CELL_NORMAL), Paragraph("Positive deflection at J point (best in V4-V6)", CELL_NORMAL), Paragraph("Hypothermia", CELL_BOLD)],
        [Paragraph("Sine wave / peaked T + wide QRS", CELL_NORMAL), Paragraph("Broad bizarre QRS; peaked T waves", CELL_NORMAL), Paragraph("Severe Hyperkalemia", CELL_BOLD)],
        [Paragraph("Deep T-inversion V1-V4 (Wellens')", CELL_NORMAL), Paragraph("Biphasic or deep symmetric T inversion V1-V4", CELL_NORMAL), Paragraph("Critical LAD stenosis — Emergency!", CELL_RED)],
        [Paragraph("Short QT + down-sloping ST", CELL_NORMAL), Paragraph("QTc <340ms, shortened ST segment", CELL_NORMAL), Paragraph("Hypercalcemia / Digoxin toxicity", CELL_BOLD)],
        [Paragraph("STEMI + reciprocal ST depression", CELL_NORMAL), Paragraph("Convex STE in territory + mirror depression", CELL_NORMAL), Paragraph("Acute Myocardial Infarction (STEMI)", CELL_RED)],
        [Paragraph("Tall R in V1 + RAD + no septal Q in V6", CELL_NORMAL), Paragraph("Dominant R in V1 (R>S), axis deviation", CELL_NORMAL), Paragraph("RBBB / RVH / Posterior MI", CELL_BOLD)],
        [Paragraph("Epsilon wave (V1-V3)", CELL_NORMAL), Paragraph("Small positive deflection after QRS in V1-V3", CELL_NORMAL), Paragraph("ARVC (Arrhythmogenic RV Cardiomyopathy)", CELL_BOLD)],
    ]
    cw_p = [W*0.30, W*0.38, W*0.32]
    pat_t = Table(pat_data, colWidths=cw_p)
    ts_pat = base_ts(header_bg=C_DARK)
    ts_pat.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_LIGHT])
    pat_t.setStyle(ts_pat)
    story.append(pat_t)
    story.append(Spacer(1, 3*mm))

    # ── STEMI TERRITORIES TABLE ───────────────────────────────────────────────
    story.append(section_label("❤️  STEMI LOCALISATION", C_RED))
    story.append(Spacer(1, 2*mm))

    stemi_data = [
        [Paragraph("Leads with STE", CELL_BOLD), Paragraph("Territory", CELL_BOLD),
         Paragraph("Culprit", CELL_BOLD), Paragraph("Reciprocal Changes", CELL_BOLD)],
        [Paragraph("II, III, aVF", CELL_NORMAL),   Paragraph("Inferior", CELL_NORMAL),    Paragraph("RCA (85%)", CELL_NORMAL), Paragraph("I, aVL", CELL_NORMAL)],
        [Paragraph("V1 – V4", CELL_NORMAL),         Paragraph("Anterior", CELL_NORMAL),    Paragraph("LAD", CELL_NORMAL),       Paragraph("II, III, aVF", CELL_NORMAL)],
        [Paragraph("V1 – V2", CELL_NORMAL),         Paragraph("Septal", CELL_NORMAL),      Paragraph("LAD proximal", CELL_NORMAL), Paragraph("None typical", CELL_NORMAL)],
        [Paragraph("I, aVL, V5–V6", CELL_NORMAL),  Paragraph("Lateral", CELL_NORMAL),     Paragraph("LCx", CELL_NORMAL),       Paragraph("II, III, aVF", CELL_NORMAL)],
        [Paragraph("V1-V3 tall R + ST depression", CELL_NORMAL), Paragraph("Posterior", CELL_NORMAL), Paragraph("RCA/LCx", CELL_NORMAL), Paragraph("(Mirror image in V1-V3)", CELL_NORMAL)],
        [Paragraph("aVR STE + diffuse depression", CELL_NORMAL), Paragraph("LMCA/prox LAD", CELL_NORMAL), Paragraph("LMCA or LAD", CELL_NORMAL), Paragraph("Diffuse ST depression", CELL_NORMAL)],
    ]
    cw_s = [W*0.25, W*0.20, W*0.22, W*0.33]
    stemi_t = Table(stemi_data, colWidths=cw_s)
    ts_s = base_ts(header_bg=C_RED)
    ts_s.add('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_BG_RED])
    stemi_t.setStyle(ts_s)
    story.append(stemi_t)
    story.append(Spacer(1, 3*mm))

    # ── FOOTER ────────────────────────────────────────────────────────────────
    story.append(HRFlowable(width=W, thickness=0.5, color=C_GRAY))
    story.append(Spacer(1, 1*mm))
    story.append(Paragraph(
        "Sources: Harrison's Principles of Internal Medicine 22E (2025) | Ganong's Review of Medical Physiology 26E | Braunwald's Heart Disease 12E     •     Page 2 of 2",
        FOOTER_STYLE))

    return story


# ══════════════════════════════════════════════════════════════════════════════
# BUILD PDF
# ══════════════════════════════════════════════════════════════════════════════

def build_pdf():
    doc = SimpleDocTemplate(
        OUTPUT_PATH,
        pagesize=A4,
        leftMargin=MARGIN, rightMargin=MARGIN,
        topMargin=MARGIN, bottomMargin=MARGIN,
        title="ECG Quick Reference Guide",
        author="Orris Medical AI",
        subject="ECG Normal Values and Diagnostic Criteria",
    )

    story = []
    story += build_page1()
    from reportlab.platypus import PageBreak
    story.append(PageBreak())
    story += build_page2()

    doc.build(story)
    size_kb = os.path.getsize(OUTPUT_PATH) // 1024
    print(f"PDF created: {OUTPUT_PATH}  ({size_kb} KB)")

if __name__ == "__main__":
    build_pdf()

Running Command

cd /home/daytona/workspace/ecg-pdf && python create_ecg_pdf.py 2>&1

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