const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");
const React = require("react");
const ReactDOMServer = require("react-dom/server");
const sharp = require("sharp");

// ── Color palette ──────────────────────────────────────────────
const C = {
  bg:        "0D1B2A",   // deep navy
  bgLight:   "112233",   // slightly lighter navy
  card:      "172A3A",   // card background
  accent:    "E63946",   // vivid crimson (heart red)
  accent2:   "F4A261",   // amber
  teal:      "2EC4B6",   // teal highlight
  white:     "FFFFFF",
  lightGray: "CBD5E0",
  midGray:   "8899AA",
  green:     "4CC9A0",
};

// ── Image URLs to embed ────────────────────────────────────────
const IMAGE_URLS = [
  // Coronary atherosclerosis cross-section (Robbins)
  "https://cdn.orris.care/cdss_images/c25e55f0ebe26e74e47efb9a7a971d85f3064bafb8d3880b2ff977ea6b47abd9.png",
  // Coronary thrombosis (Robbins)
  "https://cdn.orris.care/cdss_images/b3d63c9d3407bdd7a3ce9a5abb6262c92b82d69821e5a1bbf96b509487f45ea3.png",
  // Myocardial perfusion/necrosis wavefront diagram
  "https://cdn.orris.care/cdss_images/caa3ad3e817d1d71344be795be7da1b45e17d7b029c678d8e1272235039471f8.png",
  // ACC/AHA reperfusion strategies
  "https://ecgwaves.com/wp-content/uploads/2024/07/reperfusion-strategies-guidelines-stemi-nstemi-pci-fibrinolysis-revascularization.png",
  // ACS spectrum (ECG classification)
  "https://cardvasc.org/wp-content/uploads/2016/09/acute-coronary-syndrome-nstemi-diagnosis-criteria-myocardial-infarction-unstable-angina-ecg.jpg",
];

// Download images as base64
let images = [];
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${IMAGE_URLS.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString();
  images = JSON.parse(raw);
} catch(e) {
  console.error("Image fetch error:", e.message);
  images = IMAGE_URLS.map(() => ({ base64: null, error: "failed" }));
}

function img(i) { return images[i] && !images[i].error ? images[i].base64 : null; }

// ── Helper: bold accent text ───────────────────────────────────
function accentText(text, rest) {
  return [{ text, options: { color: C.accent, bold: true } }, { text: rest || "", options: {} }];
}

// ── Build presentation ─────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "Myocardial Infarction – Medicine Department Seminar";
pres.author = "Medicine Department";

// ── Shared background helper ───────────────────────────────────
function darkBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.bg } });
}

function sectionHeader(slide, title, subtitle) {
  darkBg(slide);
  // accent bar left
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.08, h: 5.625, fill: { color: C.accent } });
  slide.addText(title, {
    x: 0.4, y: 1.6, w: 9.2, h: 1.0,
    fontSize: 40, bold: true, color: C.white, fontFace: "Calibri", align: "center"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.4, y: 2.7, w: 9.2, h: 0.6,
      fontSize: 20, color: C.accent2, fontFace: "Calibri", align: "center"
    });
  }
}

function contentSlide(slide, title) {
  darkBg(slide);
  // top accent bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.accent } });
  slide.addText(title, {
    x: 0.3, y: 0.06, w: 9.4, h: 0.44,
    fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  // thin teal bottom bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.45, w: 10, h: 0.17, fill: { color: C.teal } });
  slide.addText("Medicine Department Seminar · MI 2025", {
    x: 0.3, y: 5.45, w: 9.4, h: 0.17, fontSize: 8, color: C.bg, fontFace: "Calibri", valign: "middle"
  });
}

function addBullets(slide, items, opts = {}) {
  const textArr = items.map((it, i) => ({
    text: typeof it === "string" ? it : it.text,
    options: {
      bullet: { indent: typeof it === "object" && it.sub ? 30 : 10 },
      color: typeof it === "object" && it.sub ? C.lightGray : C.white,
      fontSize: typeof it === "object" && it.sub ? 13 : 15,
      breakLine: true,
      bold: typeof it === "object" && it.bold ? true : false,
      ...((typeof it === "object" && it.options) ? it.options : {})
    }
  }));
  slide.addText(textArr, {
    x: opts.x ?? 0.4,
    y: opts.y ?? 0.65,
    w: opts.w ?? 9.2,
    h: opts.h ?? 4.6,
    fontFace: "Calibri",
    valign: "top",
    lineSpacingMultiple: 1.3,
  });
}

function card(slide, x, y, w, h, title, body, titleColor) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: C.card },
    line: { color: titleColor || C.teal, width: 1.5 },
    rectRadius: 0.1
  });
  slide.addText(title, {
    x: x + 0.12, y: y + 0.07, w: w - 0.24, h: 0.32,
    fontSize: 12, bold: true, color: titleColor || C.teal, fontFace: "Calibri"
  });
  slide.addText(body, {
    x: x + 0.12, y: y + 0.38, w: w - 0.24, h: h - 0.5,
    fontSize: 12, color: C.lightGray, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.25
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 1 — Title
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  // decorative heart-red circle backdrop
  s.addShape(pres.ShapeType.ellipse, { x: 6.5, y: -1, w: 5, h: 5, fill: { color: C.accent }, line: { type: "none" }, transparency: 80 });
  s.addShape(pres.ShapeType.ellipse, { x: -1.5, y: 2.5, w: 4, h: 4, fill: { color: C.teal }, line: { type: "none" }, transparency: 85 });
  s.addText("MYOCARDIAL INFARCTION", {
    x: 0.5, y: 0.8, w: 9, h: 0.8,
    fontSize: 38, bold: true, color: C.accent, fontFace: "Calibri",
    charSpacing: 4, align: "center"
  });
  s.addText("Heart Attack – Pathophysiology, Diagnosis & Management", {
    x: 0.5, y: 1.7, w: 9, h: 0.55,
    fontSize: 20, color: C.lightGray, fontFace: "Calibri", align: "center"
  });
  s.addShape(pres.ShapeType.rect, { x: 2.5, y: 2.35, w: 5, h: 0.04, fill: { color: C.accent2 } });
  s.addText("Medicine Department Seminar", {
    x: 0.5, y: 2.5, w: 9, h: 0.4,
    fontSize: 16, color: C.accent2, fontFace: "Calibri", align: "center"
  });
  s.addText("Based on Braunwald's Heart Disease | Robbins Pathology | 2025 ACC/AHA Guidelines", {
    x: 0.5, y: 3.1, w: 9, h: 0.35,
    fontSize: 11, color: C.midGray, fontFace: "Calibri", align: "center", italic: true
  });
  s.addText("June 2026", {
    x: 0.5, y: 4.9, w: 9, h: 0.3,
    fontSize: 12, color: C.midGray, fontFace: "Calibri", align: "center"
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 2 — Overview / Agenda
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Seminar Agenda");
  const topics = [
    "01  Epidemiology & Burden of Disease",
    "02  Pathophysiology – Plaque Rupture & Coronary Occlusion",
    "03  Universal Definition – Types of MI",
    "04  Clinical Presentation",
    "05  ECG Changes & Localisation",
    "06  Biomarkers – Troponin & More",
    "07  Imaging – Echo, Angiography",
    "08  Risk Stratification – TIMI & GRACE",
    "09  STEMI Management Flowchart",
    "10  NSTE-ACS Management Flowchart",
    "11  Pharmacotherapy",
    "12  Complications",
    "13  Secondary Prevention",
    "14  Emerging Concepts (OMI Paradigm)",
    "15  Take-Home Messages"
  ];
  const col1 = topics.slice(0, 8);
  const col2 = topics.slice(8);
  col1.forEach((t, i) => {
    const y = 0.75 + i * 0.59;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y: y + 0.05, w: 0.28, h: 0.3, fill: { color: C.accent }, line: { type: "none" } });
    s.addText(t, { x: 0.72, y: y, w: 4.3, h: 0.38, fontSize: 13, color: C.white, fontFace: "Calibri" });
  });
  col2.forEach((t, i) => {
    const y = 0.75 + i * 0.59;
    s.addShape(pres.ShapeType.rect, { x: 5.2, y: y + 0.05, w: 0.28, h: 0.3, fill: { color: C.teal }, line: { type: "none" } });
    s.addText(t, { x: 5.58, y: y, w: 4.1, h: 0.38, fontSize: 13, color: C.white, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 3 — Epidemiology
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Epidemiology & Global Burden");
  // 4 stat cards
  const stats = [
    { title: "Global MI Deaths/Year", val: "~9 Million", sub: "#1 cause of death worldwide", col: C.accent },
    { title: "US STEMI Events/Year", val: "~500,000", sub: "0.5M STEMI events annually", col: C.accent2 },
    { title: "Age at First MI – Men", val: "<65 years", sub: "45% of all MIs occur <65 yrs", col: C.teal },
    { title: "Gender Gap", val: "M > F", sub: "Gap narrows after female menopause", col: C.green },
  ];
  stats.forEach((st, i) => {
    const x = 0.3 + i * 2.38;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.72, w: 2.25, h: 1.5, fill: { color: C.card }, line: { color: st.col, width: 2 }, rectRadius: 0.12 });
    s.addText(st.title, { x: x + 0.1, y: 0.75, w: 2.05, h: 0.4, fontSize: 11, color: st.col, bold: true, fontFace: "Calibri" });
    s.addText(st.val, { x: x + 0.1, y: 1.15, w: 2.05, h: 0.45, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
    s.addText(st.sub, { x: x + 0.1, y: 1.6, w: 2.05, h: 0.55, fontSize: 10, color: C.lightGray, fontFace: "Calibri", align: "center" });
  });
  // Key risk factors
  s.addText("KEY RISK FACTORS", { x: 0.3, y: 2.42, w: 4, h: 0.3, fontSize: 12, bold: true, color: C.accent2, fontFace: "Calibri" });
  const rf = ["Hypertension", "Diabetes mellitus", "Dyslipidaemia", "Smoking", "Obesity / metabolic syndrome", "Family history", "Physical inactivity", "Age & male sex"];
  rf.forEach((r, i) => {
    const col = i < 4 ? 0.3 : 5.1;
    const row = i < 4 ? i : i - 4;
    s.addShape(pres.ShapeType.ellipse, { x: col, y: 2.82 + row * 0.55, w: 0.18, h: 0.18, fill: { color: C.accent }, line: { type: "none" } });
    s.addText(r, { x: col + 0.26, y: 2.8 + row * 0.55, w: 4.2, h: 0.28, fontSize: 13, color: C.white, fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 4 — Pathophysiology with image
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Pathophysiology – Plaque Rupture & Coronary Occlusion");

  addBullets(s, [
    { text: "Atherosclerotic plaque erosion/rupture exposes subendothelial collagen", bold: true },
    { text: "→ Platelet adhesion → aggregation → thromboxane A2, ADP, serotonin release", sub: true },
    { text: "Coagulation activation via tissue factor exposure → growing thrombus", bold: true },
    { text: "→ Complete occlusion within minutes", sub: true },
    { text: "Aerobic metabolism ceases within seconds → ATP drop + lactic acid", bold: true },
    { text: "→ Irreversible necrosis if ischemia persists > 20–40 minutes", sub: true },
    { text: "Subendocardial zone is most vulnerable (furthest from epicardial supply)", bold: true },
    { text: "Cell death wavefront progresses from subendocardium → epicardium", sub: true },
    { text: "80–90% of cardiac deaths: ventricular fibrillation from myocardial irritability", bold: true },
  ], { x: 0.35, y: 0.65, w: 5.3, h: 4.65 });

  // Image: coronary thrombosis
  if (img(1)) {
    s.addImage({ data: img(1), x: 5.85, y: 0.7, w: 3.8, h: 2.4, sizing: { type: "contain", w: 3.8, h: 2.4 } });
    s.addText("Coronary thrombosis – nearly occluded artery (Robbins Pathology)", {
      x: 5.85, y: 3.12, w: 3.8, h: 0.32, fontSize: 9, color: C.midGray, fontFace: "Calibri", italic: true, align: "center"
    });
  }
  // Image: wavefront necrosis
  if (img(2)) {
    s.addImage({ data: img(2), x: 5.85, y: 3.5, w: 3.8, h: 1.75, sizing: { type: "contain", w: 3.8, h: 1.75 } });
    s.addText("Wavefront of cell death: subendocardium → epicardium", {
      x: 5.85, y: 5.25, w: 3.8, h: 0.2, fontSize: 9, color: C.midGray, fontFace: "Calibri", italic: true, align: "center"
    });
  }
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 5 — Universal Definition / Types of MI
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Universal Definition – Types of MI (4th Universal Definition 2018)");

  s.addText("MI = acute myocardial injury detected by abnormal cardiac biomarkers + evidence of acute myocardial ischemia", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.45, fontSize: 13, color: C.accent2, fontFace: "Calibri", bold: true
  });

  const types = [
    { type: "Type 1", name: "Spontaneous MI", desc: "Plaque rupture/erosion → coronary thrombosis", col: C.accent },
    { type: "Type 2", name: "Demand Ischaemia MI", desc: "O2 supply-demand mismatch (e.g. tachyarrhythmia, anaemia, vasospasm)", col: C.accent2 },
    { type: "Type 3", name: "MI causing death", desc: "Sudden cardiac death before biomarkers obtained", col: C.teal },
    { type: "Type 4a", name: "PCI-related MI", desc: "≥5× 99th percentile of URL in first 48 h after PCI", col: C.green },
    { type: "Type 4b", name: "Stent thrombosis MI", desc: "Confirmed by angiography or autopsy", col: C.green },
    { type: "Type 5", name: "CABG-related MI", desc: "≥10× 99th percentile of URL + new LBBB or graft occlusion", col: C.midGray },
  ];
  types.forEach((t, i) => {
    const row = Math.floor(i / 3);
    const col = i % 3;
    const x = 0.3 + col * 3.2;
    const y = 1.25 + row * 1.75;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.1, h: 1.6, fill: { color: C.card }, line: { color: t.col, width: 2 }, rectRadius: 0.1 });
    s.addText(t.type, { x: x + 0.12, y: y + 0.1, w: 1.2, h: 0.32, fontSize: 13, bold: true, color: t.col, fontFace: "Calibri" });
    s.addText(t.name, { x: x + 0.12, y: y + 0.42, w: 2.85, h: 0.3, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri" });
    s.addText(t.desc, { x: x + 0.12, y: y + 0.74, w: 2.85, h: 0.8, fontSize: 11, color: C.lightGray, fontFace: "Calibri", lineSpacingMultiple: 1.2 });
  });

  s.addText("URL = Upper Reference Limit of 99th percentile · PCI = Percutaneous Coronary Intervention · CABG = Coronary Artery Bypass Graft", {
    x: 0.3, y: 5.25, w: 9.4, h: 0.2, fontSize: 8, color: C.midGray, fontFace: "Calibri", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 6 — Clinical Presentation
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Clinical Presentation");

  // typical
  s.addText("TYPICAL PRESENTATION", { x: 0.3, y: 0.65, w: 4.4, h: 0.3, fontSize: 12, bold: true, color: C.accent, fontFace: "Calibri" });
  const typical = [
    "Severe crushing/pressure chest pain radiating to jaw, left arm, shoulder",
    "Duration > 20 min, NOT relieved by nitrates",
    "Diaphoresis, nausea, vomiting",
    "Dyspnoea, anxiety, sense of impending doom",
    "S4 gallop (stiff, non-compliant LV)",
    "New MR murmur (papillary muscle dysfunction)",
    "Hypotension / cardiogenic shock (large infarcts)",
  ];
  addBullets(s, typical, { x: 0.3, y: 0.97, w: 4.6, h: 3.5 });

  // atypical
  s.addText("ATYPICAL / SILENT MI", { x: 5.2, y: 0.65, w: 4.4, h: 0.3, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri" });
  const atypical = [
    "Epigastric pain, indigestion (inferior MI)",
    "Jaw/neck pain only",
    "Syncope or sudden collapse",
    "Acute confusion (elderly)",
    "Diabetics – minimal/no symptoms",
    "Women – fatigue, nausea more prominent",
    "Silent MI: ~20% of all cases",
  ];
  addBullets(s, atypical, { x: 5.2, y: 0.97, w: 4.5, h: 3.5 });

  // divider
  s.addShape(pres.ShapeType.line, { x: 4.95, y: 0.65, w: 0, h: 4.6, line: { color: C.midGray, width: 1 } });

  s.addText("'Time is Myocardium' – every 30 min delay costs ~150,000 cardiomyocytes", {
    x: 0.3, y: 4.75, w: 9.4, h: 0.4,
    fontSize: 12, color: C.accent2, bold: true, fontFace: "Calibri", align: "center"
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 7 — ECG Changes (with ACS spectrum image)
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "ECG Changes & Localisation of MI");

  const ecgData = [
    ["Hyperacute T-waves", "Tall, peaked T-waves", "Earliest change, minutes"],
    ["ST elevation (STEMI)", "≥1 mm (limb leads), ≥2 mm (V1–V4)", "Transmural injury current"],
    ["ST depression", "Horizontal/downsloping", "NSTEMI / reciprocal"],
    ["T-wave inversion", "Symmetric deep inversion", "Ischaemia, hours-days"],
    ["Pathologic Q-waves", ">40 ms wide, >25% R height", "Necrosis (irreversible)"],
    ["New LBBB", "Occludes LAD", "STEMI equivalent"],
  ];
  const hdrs = ["ECG Finding", "Criteria", "Significance"];
  hdrs.forEach((h, i) => {
    s.addText(h, { x: 0.3 + i * 2.35, y: 0.65, w: 2.3, h: 0.3, fontSize: 11, bold: true, color: C.accent, fontFace: "Calibri" });
  });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.93, w: 7.05, h: 0.03, fill: { color: C.accent } });
  ecgData.forEach((row, i) => {
    const bgColor = i % 2 === 0 ? C.card : C.bgLight;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.96 + i * 0.52, w: 7.05, h: 0.5, fill: { color: bgColor }, line: { type: "none" } });
    row.forEach((cell, j) => {
      s.addText(cell, { x: 0.35 + j * 2.35, y: 0.98 + i * 0.52, w: 2.28, h: 0.46, fontSize: 11.5, color: j === 0 ? C.white : C.lightGray, fontFace: "Calibri", valign: "middle", bold: j === 0 });
    });
  });

  // Localisation table header
  s.addText("ECG LOCALISATION", { x: 0.3, y: 4.15, w: 5, h: 0.3, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri" });
  const locData = [
    ["Anterior", "V1–V4", "LAD (proximal)"],
    ["Inferior", "II, III, aVF", "RCA (80%) / LCx"],
    ["Lateral", "I, aVL, V5–V6", "LCx / Diagonal"],
    ["Posterior", "V1–V2 (tall R, ST↓)", "RCA / LCx"],
    ["Right Ventricle", "V3R–V4R (ST↑)", "RCA proximal"],
  ];
  locData.forEach((r, i) => {
    s.addText(`${r[0]} – Leads: ${r[1]} – ${r[2]}`, {
      x: 0.3, y: 4.48 + i * 0.19, w: 7.05, h: 0.2,
      fontSize: 10.5, color: i % 2 === 0 ? C.white : C.lightGray, fontFace: "Calibri"
    });
  });

  // ACS spectrum image
  if (img(4)) {
    s.addImage({ data: img(4), x: 7.5, y: 0.65, w: 2.3, h: 4.55, sizing: { type: "contain", w: 2.3, h: 4.55 } });
  }
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 8 — Biomarkers
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Cardiac Biomarkers – Diagnosis & Kinetics");

  const markers = [
    { name: "hsTroponin I / T", rise: "1–3 h", peak: "12–24 h", norm: "14 days", note: "Gold standard; highly sensitive", col: C.accent },
    { name: "CK-MB", rise: "3–8 h", peak: "18–24 h", norm: "48–72 h", note: "Useful for re-infarction detection", col: C.accent2 },
    { name: "Myoglobin", rise: "1–4 h", peak: "6–10 h", norm: "24 h", note: "Early marker, low specificity", col: C.teal },
    { name: "LDH", rise: "6–12 h", peak: "24–48 h", norm: "10–14 days", note: "Useful in late presentation", col: C.green },
  ];
  markers.forEach((m, i) => {
    const x = 0.28 + i * 2.38;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.7, w: 2.28, h: 3.2, fill: { color: C.card }, line: { color: m.col, width: 2 }, rectRadius: 0.1 });
    s.addText(m.name, { x: x + 0.1, y: 0.74, w: 2.08, h: 0.45, fontSize: 13, bold: true, color: m.col, fontFace: "Calibri" });
    s.addText(`Rises: ${m.rise}`, { x: x + 0.1, y: 1.2, w: 2.08, h: 0.3, fontSize: 12, color: C.lightGray, fontFace: "Calibri" });
    s.addText(`Peaks: ${m.peak}`, { x: x + 0.1, y: 1.5, w: 2.08, h: 0.3, fontSize: 12, color: C.lightGray, fontFace: "Calibri" });
    s.addText(`Normalises: ${m.norm}`, { x: x + 0.1, y: 1.8, w: 2.08, h: 0.3, fontSize: 12, color: C.lightGray, fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: x + 0.1, y: 2.15, w: 2.05, h: 0.02, fill: { color: C.midGray } });
    s.addText(m.note, { x: x + 0.1, y: 2.2, w: 2.08, h: 0.65, fontSize: 11, color: C.white, fontFace: "Calibri", lineSpacingMultiple: 1.2 });
  });

  s.addText("High-Sensitivity Troponin (hsTn) Protocol – Rapid Rule-Out:", {
    x: 0.3, y: 3.95, w: 9.4, h: 0.3, fontSize: 12, bold: true, color: C.accent2, fontFace: "Calibri"
  });
  const protocols = [
    "0h/1h algorithm: hsTn at 0 h and 1 h – Rule-out if both < 5 ng/L (ESC 2023)",
    "0h/3h algorithm: alternative when 0h/1h not available",
    "Delta rule: >5 ng/L rise in 1 h OR >52 ng/L absolute = rule-in for NSTEMI",
    "Serial troponin levels × 2 mandatory in all suspected ACS presentations",
  ];
  addBullets(s, protocols, { x: 0.3, y: 4.3, w: 9.4, h: 1.0 });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 9 — Imaging
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Imaging Modalities in MI");

  card(s, 0.28, 0.7, 3.1, 4.55,
    "Echocardiography (Echo)",
    "• Bedside POCUS within minutes\n• Regional wall motion abnormalities (RWMA)\n• Estimate LVEF – key for prognosis\n• Detect complications: MR, VSD, pericardial effusion, free wall rupture\n• Strain imaging: subclinical dysfunction\n• Mandatory in ALL ACS presentations",
    C.teal
  );
  card(s, 3.52, 0.7, 3.1, 4.55,
    "Coronary Angiography (Gold Standard)",
    "• Defines coronary anatomy\n• Identifies culprit lesion\n• Enables primary PCI in STEMI\n• FFR / iFR for functional assessment\n• Target: within 90 min (door-to-balloon)\n• Contrast-induced AKI: limit contrast < 3× eGFR",
    C.accent
  );
  card(s, 6.76, 0.7, 3.0, 4.55,
    "Advanced Imaging",
    "• CMR: gold standard for infarct size, myocardial viability, LGE\n• CT Coronary Angiography (CTCA): rule-out in low-intermediate risk\n• Nuclear imaging (SPECT/PET): viability/perfusion\n• CT angiography: 3D anatomy, calcium scoring",
    C.accent2
  );
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 10 — Risk Stratification
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Risk Stratification – TIMI & GRACE Scores");

  s.addText("TIMI Score (NSTE-ACS)", { x: 0.3, y: 0.67, w: 4.4, h: 0.3, fontSize: 13, bold: true, color: C.accent, fontFace: "Calibri" });
  const timiItems = [
    "Age ≥ 65 years",
    "≥3 CAD risk factors",
    "Known CAD (stenosis ≥50%)",
    "ASA use in past 7 days",
    "Severe angina (≥2 events in 24 h)",
    "ST deviation ≥0.5 mm",
    "Positive cardiac markers",
  ];
  timiItems.forEach((item, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.02 + i * 0.44, w: 0.22, h: 0.22, fill: { color: C.accent }, line: { type: "none" } });
    s.addText(`+1  ${item}`, { x: 0.6, y: 1.0 + i * 0.44, w: 4.1, h: 0.28, fontSize: 12, color: C.white, fontFace: "Calibri" });
  });
  s.addText("Score 0–2: Low risk (4.7%)\nScore 3–4: Intermediate (13–20%)\nScore 5–7: High risk (26–41%)", {
    x: 0.3, y: 4.1, w: 4.5, h: 0.9, fontSize: 11, color: C.accent2, fontFace: "Calibri", lineSpacingMultiple: 1.3
  });

  s.addShape(pres.ShapeType.line, { x: 5.0, y: 0.65, w: 0, h: 4.7, line: { color: C.midGray, width: 1 } });

  s.addText("GRACE Score", { x: 5.15, y: 0.67, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.teal, fontFace: "Calibri" });
  const graceItems = [
    { label: "Age", detail: "Continuous variable" },
    { label: "Heart rate", detail: "Continuous" },
    { label: "SBP", detail: "Continuous" },
    { label: "Creatinine", detail: "Continuous" },
    { label: "Killip class", detail: "I–IV (HF severity)" },
    { label: "Cardiac arrest at admission", detail: "+39 points" },
    { label: "ST deviation", detail: "+28 points" },
    { label: "Elevated troponin", detail: "+14 points" },
  ];
  graceItems.forEach((g, i) => {
    s.addText(`• ${g.label}: `, { x: 5.15, y: 1.02 + i * 0.44, w: 2.0, h: 0.28, fontSize: 12, color: C.white, fontFace: "Calibri", bold: true });
    s.addText(g.detail, { x: 6.45, y: 1.02 + i * 0.44, w: 3.2, h: 0.28, fontSize: 12, color: C.lightGray, fontFace: "Calibri" });
  });
  s.addText("GRACE <109: Low (<3%)\nGRACE 109–140: Intermediate (3–6%)\nGRACE >140: High (>6%) in-hospital mortality", {
    x: 5.15, y: 4.1, w: 4.5, h: 0.9, fontSize: 11, color: C.teal, fontFace: "Calibri", lineSpacingMultiple: 1.3
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 11 — STEMI Management Flowchart
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "STEMI Management Flowchart (2025 ACC/AHA Guidelines)");

  // Flowchart boxes
  function fbox(x, y, w, h, text, fill, textColor, fontSize) {
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: fill }, line: { color: C.white, width: 1 }, rectRadius: 0.08 });
    s.addText(text, { x: x + 0.05, y: y + 0.04, w: w - 0.1, h: h - 0.08, fontSize: fontSize || 11, color: textColor || C.white, fontFace: "Calibri", align: "center", valign: "middle", bold: true });
  }
  function arrow(x, y, h) {
    s.addShape(pres.ShapeType.line, { x, y, w: 0, h, line: { color: C.accent2, width: 2 } });
    s.addShape(pres.ShapeType.triangle, { x: x - 0.08, y: y + h - 0.04, w: 0.16, h: 0.16, fill: { color: C.accent2 }, line: { type: "none" } });
  }
  function harrow(x, y, w, dir) {
    s.addShape(pres.ShapeType.line, { x, y, w, h: 0, line: { color: C.accent2, width: 2 } });
    const ax = dir === "right" ? x + w - 0.04 : x;
    s.addShape(pres.ShapeType.triangle, { x: ax - 0.08, y: y - 0.08, w: 0.16, h: 0.16, fill: { color: C.accent2 }, line: { type: "none" }, rotate: dir === "right" ? 90 : 270 });
  }

  fbox(3.2, 0.67, 3.6, 0.5, "Suspected STEMI: Chest Pain + ECG Changes", C.accent, C.white, 10.5);
  arrow(5.0, 1.17, 0.2);
  fbox(3.2, 1.37, 3.6, 0.45, "12-Lead ECG within 10 min + hsTroponin", C.card, C.accent2, 10.5);
  arrow(5.0, 1.82, 0.2);
  fbox(3.2, 2.02, 3.6, 0.42, "STEMI Criteria Met? (ST↑ ≥2 mm ≥2 contiguous leads / LBBB)", C.bgLight, C.white, 9.5);

  arrow(5.0, 2.44, 0.22);
  // YES branch
  fbox(1.0, 2.66, 1.6, 0.4, "YES →", C.green, C.bg, 11);
  // branch
  harrow(1.8, 2.86, 1.35, "right");
  fbox(0.15, 3.1, 1.8, 0.55, "PCI-capable centre\nwithin 120 min?", C.card, C.teal, 10);
  arrow(1.05, 3.65, 0.22);
  fbox(0.15, 3.87, 1.8, 0.5, "Primary PCI\nD2B ≤ 90 min", C.green, C.bg, 11);
  fbox(2.05, 3.1, 1.8, 0.55, "No PCI available\n< 120 min", C.card, C.accent2, 10);
  arrow(2.95, 3.65, 0.22);
  fbox(2.05, 3.87, 1.8, 0.5, "Fibrinolysis\nwithin 30 min", C.accent2, C.bg, 11);

  // medications
  fbox(4.5, 2.66, 5.35, 0.4, "Immediate Medications: Aspirin 300 mg + P2Y12 (Ticagrelor 180 mg) + Heparin UFH/LMWH", C.accent, C.white, 10);
  fbox(4.5, 3.1, 5.35, 0.5, "Supplemental O2 (if SaO2 < 90%) · GTN (if not hypotensive)\nMorphine/Fentanyl · β-Blocker (if no contraindication)", C.card, C.lightGray, 10);
  fbox(4.5, 3.65, 5.35, 0.5, "Post-PCI: Dual antiplatelet × 12 months · Statin · ACEi/ARB · β-Blocker\nICU monitoring · Echo within 24 h · Cardiac rehabilitation referral", C.bgLight, C.lightGray, 10);
  fbox(4.5, 4.2, 5.35, 0.5, "Killip Classification for prognosis:\nI: No HF | II: Crackles | III: Pulmonary oedema | IV: Cardiogenic shock", C.card, C.accent2, 10);
  
  // ACC/AHA ref
  s.addText("Source: 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline (PMID: 40014670)", {
    x: 0.3, y: 5.2, w: 9.4, h: 0.2, fontSize: 8, color: C.midGray, fontFace: "Calibri", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 12 — NSTE-ACS Management Flowchart
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "NSTE-ACS Management Flowchart (NSTEMI / Unstable Angina)");

  function fbox(x, y, w, h, text, fill, textColor, fontSize) {
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: fill }, line: { color: C.white, width: 1 }, rectRadius: 0.08 });
    s.addText(text, { x: x + 0.05, y: y + 0.04, w: w - 0.1, h: h - 0.08, fontSize: fontSize || 11, color: textColor || C.white, fontFace: "Calibri", align: "center", valign: "middle", bold: true });
  }
  function arrow(x, y, h) {
    s.addShape(pres.ShapeType.line, { x, y, w: 0, h, line: { color: C.teal, width: 2 } });
    s.addShape(pres.ShapeType.triangle, { x: x - 0.08, y: y + h - 0.04, w: 0.16, h: 0.16, fill: { color: C.teal }, line: { type: "none" } });
  }

  fbox(2.9, 0.65, 4.2, 0.45, "Suspected NSTE-ACS: Chest Pain, ECG (ST↓/T-inv), hsTroponin+", C.accent, C.white, 10);
  arrow(5.0, 1.1, 0.18);
  fbox(2.9, 1.28, 4.2, 0.42, "Risk Stratify: GRACE Score + TIMI Score + Clinical Assessment", C.card, C.accent2, 10);
  arrow(5.0, 1.7, 0.18);

  // 3 branches
  const branches = [
    { x: 0.15, lbl: "VERY HIGH RISK", detail: "Haemodynamic instability\nCardiogenic shock\nRecurrent refractory ischaemia\nMechanical complications\nNew VT/VF", action: "Immediate invasive\n< 2 hours", col: C.accent },
    { x: 3.35, lbl: "HIGH RISK", detail: "GRACE >140\nTroponin rise/fall\nNew ST changes\nNew regional RWMA", action: "Early invasive\n< 24 hours", col: C.accent2 },
    { x: 6.55, lbl: "LOW–INTERMEDIATE", detail: "GRACE <140\nNo troponin rise\nNo ST changes\nStable haemodynamics", action: "Conservative or\nelective angiography\n< 72 hours", col: C.teal },
  ];
  branches.forEach(b => {
    s.addShape(pres.ShapeType.roundRect, { x: b.x, y: 1.9, w: 3.1, h: 0.35, fill: { color: b.col }, line: { type: "none" }, rectRadius: 0.05 });
    s.addText(b.lbl, { x: b.x + 0.1, y: 1.9, w: 2.9, h: 0.35, fontSize: 11, bold: true, color: b.col === C.accent2 ? C.bg : C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.roundRect, { x: b.x, y: 2.28, w: 3.1, h: 1.2, fill: { color: C.card }, line: { color: b.col, width: 1.5 }, rectRadius: 0.07 });
    s.addText(b.detail, { x: b.x + 0.1, y: 2.3, w: 2.9, h: 1.14, fontSize: 11, color: C.lightGray, fontFace: "Calibri", valign: "middle" });
    s.addShape(pres.ShapeType.roundRect, { x: b.x, y: 3.53, w: 3.1, h: 0.55, fill: { color: b.col }, line: { type: "none" }, rectRadius: 0.07 });
    s.addText(b.action, { x: b.x + 0.1, y: 3.53, w: 2.9, h: 0.55, fontSize: 11, bold: true, color: b.col === C.accent2 ? C.bg : C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  fbox(0.15, 4.15, 9.7, 0.42, "Pharmacotherapy (ALL): Aspirin + P2Y12 + Anticoagulation (UFH/LMWH/Fondaparinux) + High-dose statin + β-Blocker + ACEi", C.bgLight, C.lightGray, 10);
  fbox(0.15, 4.6, 9.7, 0.42, "Additional: GP IIb/IIIa inhibitors for high-risk PCI · Glycaemic control · Treat precipitating factors (anaemia, infection)", C.card, C.lightGray, 10);
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 13 — Pharmacotherapy
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Pharmacotherapy – Acute & Long-Term");

  const drugs = [
    {
      cat: "Antiplatelets",
      col: C.accent,
      items: ["Aspirin 300 mg loading → 75 mg OD life-long", "Ticagrelor 180 mg → 90 mg BD (preferred over clopidogrel)", "Clopidogrel 600 mg if ticagrelor/prasugrel contraindicated", "DAPT × 12 months post-ACS"],
    },
    {
      cat: "Anticoagulants",
      col: C.accent2,
      items: ["UFH: 60 U/kg bolus → infusion (target aPTT 50–70 s)", "LMWH: Enoxaparin 1 mg/kg SC BD", "Fondaparinux: 2.5 mg SC OD (NSTE-ACS)", "Bivalirudin: preferred in primary PCI (less bleeding)"],
    },
    {
      cat: "Other Acute Agents",
      col: C.teal,
      items: ["GTN: sublingual/IV (not if BP < 90 mmHg)", "Opioids: Morphine/Fentanyl for pain (use judiciously)", "O2: only if SaO2 < 90%", "β-Blocker: IV Metoprolol if HR>60, no HF"],
    },
    {
      cat: "Long-Term Secondary Prev.",
      col: C.green,
      items: ["High-intensity statin: Atorvastatin 40–80 mg (target LDL < 1.4 mmol/L)", "ACEi: Ramipril 10 mg OD (all post-MI, especially if LVEF <40%)", "β-Blocker: Bisoprolol/Carvedilol (LVEF <40%)", "Eplerenone/Spironolactone: LVEF <35%"],
    },
  ];
  drugs.forEach((d, i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    const x = 0.25 + col * 4.88;
    const y = 0.67 + row * 2.36;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.72, h: 2.22, fill: { color: C.card }, line: { color: d.col, width: 2 }, rectRadius: 0.1 });
    s.addText(d.cat, { x: x + 0.12, y: y + 0.07, w: 4.48, h: 0.33, fontSize: 13, bold: true, color: d.col, fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: x + 0.12, y: y + 0.4, w: 4.45, h: 0.02, fill: { color: d.col } });
    const textArr = d.items.map((t, ii) => ({
      text: t, options: { bullet: { indent: 10 }, color: C.lightGray, fontSize: 11.5, breakLine: ii < d.items.length - 1 }
    }));
    s.addText(textArr, { x: x + 0.12, y: y + 0.46, w: 4.48, h: 1.65, fontFace: "Calibri", lineSpacingMultiple: 1.25, valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 14 — Complications
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Complications of MI");

  const comps = [
    { time: "Immediate\n(0–24 h)", items: ["VF / VT – most common cause of death", "Heart block (esp. inferior MI → RCA)", "Cardiogenic shock", "Electromechanical dissociation"], col: C.accent },
    { time: "Early\n(1–3 days)", items: ["Reinfarction", "Pericarditis (transmural MI)", "Free wall rupture (risk 3–5 days)", "Papillary muscle rupture → acute MR"], col: C.accent2 },
    { time: "Late\n(Days–Weeks)", items: ["Ventricular septal defect (VSD)", "LV aneurysm formation", "Dressler syndrome (2–6 weeks)", "Mural thrombus → systemic emboli"], col: C.teal },
    { time: "Chronic", items: ["Heart failure (systolic/diastolic)", "Ischaemic cardiomyopathy", "Recurrent ischaemia", "Sudden cardiac death"], col: C.green },
  ];
  comps.forEach((c, i) => {
    const x = 0.25 + i * 2.42;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.68, w: 2.32, h: 4.55, fill: { color: C.card }, line: { color: c.col, width: 2 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.68, w: 2.32, h: 0.55, fill: { color: c.col }, line: { type: "none" }, rectRadius: 0.1 });
    s.addText(c.time, { x: x + 0.1, y: 0.7, w: 2.12, h: 0.5, fontSize: 11, bold: true, color: C.bg, fontFace: "Calibri", align: "center", valign: "middle" });
    const textArr = c.items.map((t, ii) => ({ text: t, options: { bullet: { indent: 10 }, color: C.lightGray, fontSize: 12, breakLine: ii < c.items.length - 1 } }));
    s.addText(textArr, { x: x + 0.12, y: 1.28, w: 2.08, h: 3.85, fontFace: "Calibri", lineSpacingMultiple: 1.5, valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 15 — Secondary Prevention
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Secondary Prevention Post-MI");

  const pillars = [
    { icon: "💊", title: "Medications", items: ["Life-long Aspirin 75 mg", "Statin: LDL < 1.4 mmol/L", "ACEi/ARB post-MI", "β-Blocker if LVEF <40%", "Eplerenone if LVEF <35%"] },
    { icon: "🏃", title: "Lifestyle", items: ["Cardiac rehab × 8 weeks", "150 min aerobic exercise/week", "Mediterranean diet", "Complete smoking cessation", "Alcohol ≤ 14 units/week"] },
    { icon: "🩺", title: "Monitoring", items: ["Echo at 6–8 weeks post-MI", "Follow-up at 2 weeks, 3 months", "Annual review", "Monitor for HF symptoms", "Holter if arrhythmia suspected"] },
    { icon: "🔬", title: "Targets", items: ["BP < 130/80 mmHg", "HbA1c < 53 mmol/mol", "BMI < 25 kg/m²", "LDL < 1.4 mmol/L", "HR 55–65 bpm (β-blocker)"] },
  ];
  pillars.forEach((p, i) => {
    const x = 0.25 + i * 2.42;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.68, w: 2.32, h: 4.55, fill: { color: C.card }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.12 });
    s.addText(p.icon + " " + p.title, { x: x + 0.1, y: 0.72, w: 2.12, h: 0.45, fontSize: 13, bold: true, color: C.teal, fontFace: "Calibri", align: "center" });
    s.addShape(pres.ShapeType.rect, { x: x + 0.1, y: 1.16, w: 2.08, h: 0.03, fill: { color: C.teal } });
    const textArr = p.items.map((t, ii) => ({ text: t, options: { bullet: { indent: 10 }, color: C.lightGray, fontSize: 12, breakLine: ii < p.items.length - 1 } }));
    s.addText(textArr, { x: x + 0.12, y: 1.24, w: 2.1, h: 3.85, fontFace: "Calibri", lineSpacingMultiple: 1.55, valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 16 — Emerging Concepts: OMI Paradigm
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Emerging Concepts – The OMI Paradigm (2024–2025)");

  s.addText("From STEMI/NSTEMI → Occlusion MI (OMI) vs. Non-Occlusion MI (NOMI)", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.38, fontSize: 14, bold: true, color: C.accent2, fontFace: "Calibri", align: "center"
  });

  const cols = [
    {
      title: "Traditional STEMI Paradigm", col: C.midGray,
      items: ["Binary: STEMI vs NSTEMI based on ECG", "~25–30% of acute coronary occlusions MISSED by STE criteria alone", "Standard 12-lead ECG misses posterior, RV, subtle STEMI equivalents", "Treatment delay if no STE even with total occlusion"],
    },
    {
      title: "OMI Paradigm (New)", col: C.teal,
      items: ["Focus on acute coronary OCCLUSION (ACO) regardless of STE", "STEMI equivalents: Hyperacute T, de Winter pattern, Wellens, posterior MI, LBBB with Sgarbossa", "Goal: identify occluded artery → immediate cath regardless of STE", "Reduces missed STEMIs, improves outcomes"],
    },
  ];
  cols.forEach((c, i) => {
    const x = 0.25 + i * 4.88;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.12, w: 4.72, h: 3.5, fill: { color: C.card }, line: { color: c.col, width: 2 }, rectRadius: 0.1 });
    s.addText(c.title, { x: x + 0.12, y: 1.16, w: 4.48, h: 0.4, fontSize: 13, bold: true, color: c.col, fontFace: "Calibri" });
    const textArr = c.items.map((t, ii) => ({ text: t, options: { bullet: { indent: 10 }, color: C.lightGray, fontSize: 12.5, breakLine: ii < c.items.length - 1 } }));
    s.addText(textArr, { x: x + 0.12, y: 1.6, w: 4.48, h: 2.9, fontFace: "Calibri", lineSpacingMultiple: 1.4, valign: "top" });
  });

  addBullets(s, [
    { text: "Key ECG STEMI Equivalents to Recognise:", bold: true, options: { color: C.accent } },
    { text: "De Winter pattern: upsloping ST↓ + peaked T-waves in V1–V6 = proximal LAD occlusion", sub: true },
    { text: "Wellens syndrome: deep T-wave inversions in V2–V3 = critical LAD stenosis", sub: true },
    { text: "Sgarbossa criteria (≥3 points): concordant STE ≥1 mm, concordant STD V1–V3, discordant STE ≥5 mm", sub: true },
    { text: "2025 ACC/AHA: 'Standard ECG criteria will miss a significant minority of acute coronary occlusions'", sub: true },
  ], { x: 0.3, y: 4.68, w: 9.4, h: 0.85 });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 17 — Coronary anatomy image slide
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Pathological Images – Coronary Atherosclerosis");

  if (img(0)) {
    s.addImage({ data: img(0), x: 0.5, y: 0.67, w: 4.2, h: 3.2, sizing: { type: "contain", w: 4.2, h: 3.2 } });
    s.addText("Coronary Atherosclerosis: Left – 60–70% narrowing; Right – near-total occlusion from organised thrombus\n(Robbins & Kumar Basic Pathology, Elsevier)", {
      x: 0.5, y: 3.9, w: 4.2, h: 0.7, fontSize: 10.5, color: C.lightGray, fontFace: "Calibri", italic: true, align: "center"
    });
  }
  if (img(2)) {
    s.addImage({ data: img(2), x: 5.3, y: 0.67, w: 4.3, h: 3.2, sizing: { type: "contain", w: 4.3, h: 3.2 } });
    s.addText("Wavefront necrosis: Subendocardial ischaemia progresses transmurally with time\n(Robbins & Kumar Basic Pathology, Elsevier)", {
      x: 5.3, y: 3.9, w: 4.3, h: 0.7, fontSize: 10.5, color: C.lightGray, fontFace: "Calibri", italic: true, align: "center"
    });
  }
  s.addText("Key message: Time-critical intervention limits infarct size and preserves myocardium", {
    x: 0.3, y: 4.8, w: 9.4, h: 0.35, fontSize: 12, bold: true, color: C.accent2, fontFace: "Calibri", align: "center"
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 18 — Killip Classification & Prognosis
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Killip Classification & Prognosis");

  const killip = [
    { cls: "I", desc: "No signs of heart failure", mort: "5–6%", note: "No crackles, no S3", col: C.green },
    { cls: "II", desc: "Mild HF: crackles < 50% lung fields, S3 gallop, raised JVP", mort: "10–15%", note: "Treat with diuretics", col: C.teal },
    { cls: "III", desc: "Acute pulmonary oedema: crackles > 50% lung fields", mort: "25–40%", note: "IV diuretics, NIV", col: C.accent2 },
    { cls: "IV", desc: "Cardiogenic shock: SBP < 90 mmHg + signs of hypoperfusion", mort: "55–70%", note: "IABP, vasopressors, urgent PCI", col: C.accent },
  ];
  killip.forEach((k, i) => {
    const x = 0.25 + i * 2.42;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.68, w: 2.32, h: 4.55, fill: { color: C.card }, line: { color: k.col, width: 2.5 }, rectRadius: 0.12 });
    s.addText(`CLASS ${k.cls}`, { x: x + 0.1, y: 0.72, w: 2.12, h: 0.45, fontSize: 18, bold: true, color: k.col, fontFace: "Calibri", align: "center" });
    s.addShape(pres.ShapeType.rect, { x: x + 0.1, y: 1.18, w: 2.12, h: 0.03, fill: { color: k.col } });
    s.addText(k.desc, { x: x + 0.12, y: 1.25, w: 2.08, h: 1.3, fontSize: 11, color: C.white, fontFace: "Calibri", lineSpacingMultiple: 1.3 });
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    s.addText(`Mortality\n${k.mort}`, { x: x + 0.12, y: 2.6, w: 2.08, h: 0.55, fontSize: 13, bold: true, color: C.bg, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(k.note, { x: x + 0.12, y: 3.22, w: 2.08, h: 1.8, fontSize: 11, color: C.lightGray, fontFace: "Calibri", lineSpacingMultiple: 1.3 });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 19 — Take-Home Messages
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  contentSlide(s, "Take-Home Messages");

  const msgs = [
    { num: "01", msg: "Time is myocardium – D2B ≤ 90 min for STEMI; every 30 min delay = 150,000 cardiomyocytes lost" },
    { num: "02", msg: "hsTroponin 0h/1h protocol is the standard for rapid rule-in/rule-out of NSTEMI" },
    { num: "03", msg: "Primary PCI is superior to fibrinolysis – organise systems of care to achieve timely PCI" },
    { num: "04", msg: "GRACE score guides invasive timing in NSTE-ACS; very-high risk = immediate invasive < 2 hours" },
    { num: "05", msg: "Standard STEMI criteria miss ~25% of acute occlusions – learn OMI ECG equivalents (de Winter, Wellens, Sgarbossa)" },
    { num: "06", msg: "Post-MI: Life-long DAPT × 12 months, high-intensity statin, ACEi/ARB, β-blocker, cardiac rehab" },
    { num: "07", msg: "Echo is mandatory – assess LVEF, RWMA, and mechanical complications in all ACS patients" },
    { num: "08", msg: "Killip class at admission is a powerful independent predictor of in-hospital mortality" },
  ];
  msgs.forEach((m, i) => {
    const row = Math.floor(i / 2);
    const col = i % 2;
    const x = 0.25 + col * 4.88;
    const y = 0.67 + row * 1.15;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.72, h: 1.05, fill: { color: C.card }, line: { color: i < 4 ? C.accent : C.teal, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x: x + 0.08, y: y + 0.08, w: 0.45, h: 0.45, fill: { color: i < 4 ? C.accent : C.teal }, line: { type: "none" }, rectRadius: 0.05 });
    s.addText(m.num, { x: x + 0.08, y: y + 0.08, w: 0.45, h: 0.45, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(m.msg, { x: x + 0.62, y: y + 0.1, w: 4.0, h: 0.85, fontSize: 11.5, color: C.white, fontFace: "Calibri", lineSpacingMultiple: 1.2, valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 20 — References + End
// ═══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.6, fill: { color: C.accent } });
  s.addText("References & Further Reading", { x: 0.3, y: 0.05, w: 9.4, h: 0.5, fontSize: 18, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });

  const refs = [
    "1. Braunwald's Heart Disease, 12th Ed. – Zipes, Libby, Bonow, Mann, Tomaselli (2022, Elsevier)",
    "2. Robbins & Kumar Basic Pathology, 10th Ed. – Kumar, Abbas, Aster (2023, Elsevier)",
    "3. Ganong's Review of Medical Physiology, 26th Ed. – Barrett, Barman (2019, McGraw-Hill)",
    "4. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of ACS (PMID: 40014670)",
    "5. Thygesen K, et al. Fourth Universal Definition of MI. Eur Heart J. 2019;40(3):237-269",
    "6. Collet JP, et al. 2020 ESC Guidelines for NSTE-ACS. Eur Heart J. 2021;42(14):1289-1367",
    "7. Ibanez B, et al. 2017 ESC Guidelines for STEMI. Eur Heart J. 2018;39(2):119-177",
    "8. Smith SW, et al. The OMI Manifesto – Occlusion MI paradigm. JACC Advances 2024",
  ];

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    s.addText(r, {
      x: 0.3, y: 0.7 + i * 0.53, w: 9.4, h: 0.45,
      fontSize: 11.5, color: i % 2 === 0 ? C.white : C.lightGray, fontFace: "Calibri"
    });
  });

  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.2, w: 10, h: 0.42, fill: { color: C.card } });
  s.addText("Thank You   |   Medicine Department Seminar   |   Myocardial Infarction   |   June 2026", {
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  });
}

// ═══════════════════════════════════════════════════════════════
// Write file
// ═══════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/MI-seminar/Myocardial_Infarction_Seminar.pptx" })
  .then(() => console.log("SUCCESS: PPTX written"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/MI-seminar/build_mi_pptx.js'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/MI-seminar/build_mi_pptx.js'