MGR University BSc Cardiac Technology 3rd year Paper 1 syllabus topics semester exam

MGR University BSc Cardiac Technology 3rd year syllabus cardiology subjects

https://tnmgrmu.ac.in/images/Syllabus-and-curriculam/Allied-…

ls -la /home/daytona/workspace/ 2>/dev/null && mkdir -p /home/daytona/workspace/…

~/cardiac-tech-study/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    PageBreak, HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate
from reportlab.pdfgen import canvas as pdfcanvas

OUTPUT = "/home/daytona/workspace/cardiac-tech-study/Cardiac_Tech_3rdYear_Paper1_QuickRevision.pdf"

# ── Colors ──────────────────────────────────────────────────────────────────
DARK_BLUE   = colors.HexColor("#0D2B6B")
MED_BLUE    = colors.HexColor("#1565C0")
LIGHT_BLUE  = colors.HexColor("#E3F2FD")
ACCENT      = colors.HexColor("#C62828")
GREEN       = colors.HexColor("#1B5E20")
LIGHT_GREEN = colors.HexColor("#E8F5E9")
YELLOW_BG   = colors.HexColor("#FFF9C4")
ORANGE      = colors.HexColor("#E65100")
GREY_BG     = colors.HexColor("#F5F5F5")
WHITE       = colors.white
BLACK       = colors.black

# ── Page numbering ───────────────────────────────────────────────────────────
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    canvas.drawString(15*mm, A4[1] - 14*mm, "MGR UNIVERSITY  |  BSc Cardiac Technology – 3rd Year  |  Paper I: Cath Lab Basics")
    canvas.drawRightString(A4[0] - 15*mm, A4[1] - 14*mm, "Quick Revision Guide")
    # Footer
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    canvas.setFillColor(WHITE)
    canvas.setFont("Helvetica", 8)
    canvas.drawCentredString(A4[0]/2, 4*mm, f"Page {doc.page}")
    canvas.restoreState()

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

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

cover_title  = S("CoverTitle", fontName="Helvetica-Bold", fontSize=28,
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cover_info   = S("CoverInfo",  fontName="Helvetica",      fontSize=11,
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sec_head     = S("SecHead",    fontName="Helvetica-Bold", fontSize=13,
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sub_head     = S("SubHead",    fontName="Helvetica-Bold", fontSize=11,
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body         = S("Body",       fontName="Helvetica",      fontSize=9,
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tbl_cell_b   = S("TblCellB",   fontName="Helvetica-Bold", fontSize=8.5,
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# ── Table helper ─────────────────────────────────────────────────────────────
def make_table(data, col_widths, header_color=MED_BLUE):
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def highlight_box(content_list, bg=LIGHT_BLUE, border=MED_BLUE):
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    flat = [[item for sublist in data for item in sublist]]
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                      ("BOTTOMPADDING",(0,0), (-1,-1), 4),
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    return inner

# ── Build document ────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=15*mm, rightMargin=15*mm,
    topMargin=28*mm, bottomMargin=18*mm,
    title="Cardiac Tech 3rd Year Paper I - Quick Revision",
    author="MGR University Study Guide"
)

story = []
W = A4[0] - 30*mm  # usable width

# ═══════════════════════════════════════════════════════════════════════════════
# COVER PAGE
# ═══════════════════════════════════════════════════════════════════════════════
cover_bg = Table(
    [[Paragraph("", cover_title)]],
    colWidths=[W],
    rowHeights=[2*cm],
    style=TableStyle([("BACKGROUND",(0,0),(-1,-1),DARK_BLUE)])
)

cover_data = [
    [Paragraph("BSc CARDIAC TECHNOLOGY", cover_title)],
    [Paragraph("3rd Year  ·  Paper I", cover_sub)],
    [Paragraph("Cardiac Catheterization Laboratory – Basics", cover_sub)],
    [Spacer(1, 8)],
    [Paragraph("QUICK REVISION GUIDE", S("QR", fontName="Helvetica-Bold", fontSize=18,
               textColor=colors.HexColor("#FFD54F"), alignment=TA_CENTER))],
    [Spacer(1, 6)],
    [Paragraph("Key Definitions · Abbreviations · Normal Values · Must-Know Facts",
               cover_info)],
    [Spacer(1, 4)],
    [Paragraph("Tamil Nadu Dr. M.G.R. Medical University", cover_info)],
    [Paragraph("Semester Examination Preparation  |  2025–2026", cover_info)],
]
cover_tbl = Table(cover_data, colWidths=[W],
    style=TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), DARK_BLUE),
        ("TOPPADDING",   (0,0), (-1,-1), 8),
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        ("LEFTPADDING",  (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [8]),
    ])
)
story.append(Spacer(1, 3*cm))
story.append(cover_tbl)
story.append(Spacer(1, 1*cm))

# Disclaimer box on cover
disclaimer = highlight_box([
    Paragraph("<b>HOW TO USE:</b> This guide is structured for rapid 30-minute revision. "
              "Read definitions once, then test yourself on abbreviations. "
              "Highlight the <font color='#C62828'>RED</font> starred items — these are "
              "high-frequency exam topics.", body)
], bg=YELLOW_BG, border=ORANGE)
story.append(disclaimer)
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 1 – KEY ABBREVIATIONS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 1 — KEY ABBREVIATIONS (A–Z)", sec_head))
story.append(Spacer(1, 4))

abbr_data = [
    ["Abbreviation", "Full Form", "Clinical Significance"],
    ["ACT",  "Activated Clotting Time",         "Target 250-300 sec during PCI; monitors heparin effect"],
    ["ACS",  "Acute Coronary Syndrome",          "Spectrum: UA, NSTEMI, STEMI"],
    ["AP",   "Anteroposterior",                  "Fluoroscopy view – straight front-to-back"],
    ["ASD",  "Atrial Septal Defect",             "L-to-R shunt; O2 step-up at RA level"],
    ["AV",   "Atrioventricular",                 "Junction between atria and ventricles"],
    ["AVA",  "Aortic Valve Area",                "Normal: 2.5–3.5 cm²; Severe AS: <1.0 cm²"],
    ["BMS",  "Bare Metal Stent",                 "Steel/cobalt-chromium; restenosis rate 20–30%"],
    ["BMW",  "Balance Middle Weight",            "Standard workhorse 0.014\" PCI guidewire"],
    ["BMV",  "Balloon Mitral Valvuloplasty",     "Percutaneous treatment of mitral stenosis"],
    ["BP",   "Blood Pressure",                   "Normal: 120/80 mmHg"],
    ["CAG",  "Coronary Angiography",             "Gold standard for coronary anatomy evaluation"],
    ["CHB",  "Complete Heart Block",             "No AV conduction; indication for pacing"],
    ["CHD",  "Congenital Heart Disease",         "Structural heart defect present from birth"],
    ["CI",   "Cardiac Index",                    "CO/BSA; normal 2.4–4.0 L/min/m²"],
    ["CIN",  "Contrast-Induced Nephropathy",     "Creatinine rise >0.5 mg/dL within 48–72 hrs post-contrast"],
    ["CO",   "Cardiac Output",                   "Normal 4–8 L/min; CO = HR × SV"],
    ["CS",   "Coronary Sinus",                   "Venous drainage of heart; EP catheter site"],
    ["CTO",  "Chronic Total Occlusion",          "100% coronary blockage >3 months duration"],
    ["DES",  "Drug-Eluting Stent",               "Antiproliferative drug coating; reduces restenosis"],
    ["DICOM","Digital Imaging & Communications in Medicine", "Standard for medical image storage/transfer"],
    ["EBU",  "Extra Backup Universal",           "Guide catheter for LCA with extra support"],
    ["ECG",  "Electrocardiogram",                "Records cardiac electrical activity"],
    ["EDV",  "End-Diastolic Volume",             "LV volume at end of diastole; normal ~120 mL"],
    ["EF",   "Ejection Fraction",                "EF = (EDV-ESV)/EDV × 100; normal >55%"],
    ["EP",   "Electrophysiology",                "Study of cardiac electrical conduction"],
    ["EPS",  "Electrophysiology Study",          "Invasive arrhythmia investigation"],
    ["ESV",  "End-Systolic Volume",              "LV volume at end of systole; normal ~50 mL"],
    ["EtO",  "Ethylene Oxide",                   "Gas sterilization for heat-sensitive items"],
    ["Fr",   "French",                           "Catheter size unit; 1 Fr = 0.33 mm"],
    ["GP IIb/IIIa", "Glycoprotein IIb/IIIa inhibitor", "Potent antiplatelet; abciximab, tirofiban, eptifibatide"],
    ["HV",   "His-Ventricular interval",         "Normal 35–55 ms; >70 ms = pathological"],
    ["IABP", "Intra-Aortic Balloon Pump",        "Counterpulsation device; inflates in diastole"],
    ["IC",   "Intracoronary",                    "Directly into coronary artery (drug delivery)"],
    ["IVC",  "Inferior Vena Cava",               "Returns deoxygenated blood from lower body"],
    ["IVUS", "Intravascular Ultrasound",         "Imaging inside vessel to assess stent expansion"],
    ["JL",   "Judkins Left",                     "Standard diagnostic catheter for LCA (JL4.0)"],
    ["JR",   "Judkins Right",                    "Standard diagnostic catheter for RCA (JR4.0)"],
    ["LA",   "Left Atrium",                      "Normal pressure 6–12 mmHg"],
    ["LAD",  "Left Anterior Descending",         "Supplies anterior wall, septum; 'widow maker'"],
    ["LAO",  "Left Anterior Oblique",            "C-arm rotated leftward; shows RCA, septum"],
    ["LCA",  "Left Coronary Artery",             "Divides into LAD and LCX"],
    ["LCX",  "Left Circumflex Artery",           "Supplies lateral wall, obtuse marginals"],
    ["LM",   "Left Main",                        "Trunk of LCA; critical lesion >50% needs intervention"],
    ["LV",   "Left Ventricle",                   "Main pumping chamber; systolic pressure 90–140 mmHg"],
    ["LVEDP","LV End-Diastolic Pressure",        "Normal 4–12 mmHg; elevated in heart failure"],
    ["LVEF", "Left Ventricular Ejection Fraction","Normal >55%; Severe LV dysfunction <35%"],
    ["MPA",  "Multipurpose A catheter",          "Diagnostic catheter for RHC, SVG angiography"],
    ["MR",   "Mitral Regurgitation",             "Backflow through mitral valve; graded 1+ to 4+"],
    ["MS",   "Mitral Stenosis",                  "Narrowing of mitral valve; normal MVA 4–6 cm²"],
    ["MVA",  "Mitral Valve Area",                "Normal 4–6 cm²; Severe MS: <1.0 cm²"],
    ["NAC",  "N-Acetylcysteine",                 "Antioxidant; used to prevent contrast nephropathy"],
    ["NIH",  "National Institutes of Health (catheter)", "Multi-side-hole catheter for RHC/angiography"],
    ["NSTEMI","Non-ST Elevation MI",             "Troponin positive; no ST elevation on ECG"],
    ["OCT",  "Optical Coherence Tomography",     "High-resolution intracoronary imaging"],
    ["PA",   "Pulmonary Artery",                 "Normal systolic 15–30, diastolic 4–12 mmHg"],
    ["PAP",  "Pulmonary Artery Pressure",        "Elevated in pulmonary hypertension"],
    ["PCWP", "Pulmonary Capillary Wedge Pressure","Indirect LA pressure; normal 6–12 mmHg"],
    ["PCI",  "Percutaneous Coronary Intervention","Angioplasty ± stenting"],
    ["PDA",  "Patent Ductus Arteriosus",         "O2 step-up at PA level; L-to-R shunt"],
    ["PPM",  "Permanent Pacemaker",              "Implanted device for persistent bradycardia"],
    ["PSA",  "Pacing System Analyzer",           "Device to test pacemaker lead thresholds"],
    ["PTCA", "Percutaneous Transluminal Coronary Angioplasty", "Balloon dilation of coronary stenosis"],
    ["PTFE", "Polytetrafluoroethylene",          "Covered stent material; seals perforations"],
    ["PVR",  "Pulmonary Vascular Resistance",    "Normal <3 Wood units or <250 dynes·s·cm-5"],
    ["QCA",  "Quantitative Coronary Angiography","Software to measure vessel diameter and % stenosis"],
    ["RA",   "Right Atrium",                     "Normal mean pressure 2–8 mmHg"],
    ["RAO",  "Right Anterior Oblique",           "C-arm rotated rightward; shows LAD, mitral valve"],
    ["RCA",  "Right Coronary Artery",            "Supplies inferior wall, RV, AV node (in 85%)"],
    ["RF",   "Radiofrequency",                   "Energy used in ablation; 300–750 kHz"],
    ["RHC",  "Right Heart Catheterization",      "Measures RA, RV, PA, PCWP pressures"],
    ["RV",   "Right Ventricle",                  "Systolic pressure 15–30 mmHg"],
    ["RWMA", "Regional Wall Motion Abnormality", "Hypokinesia/akinesia/dyskinesia in ischemic areas"],
    ["STEMI","ST-Elevation MI",                  "Emergency; door-to-balloon <90 min target"],
    ["SSS",  "Sick Sinus Syndrome",              "Sinus node dysfunction; indication for pacing"],
    ["SVC",  "Superior Vena Cava",               "Returns blood from upper body to RA"],
    ["SVR",  "Systemic Vascular Resistance",     "Normal 800–1500 dynes·s·cm-5"],
    ["TEE",  "Transesophageal Echocardiography", "Guides transseptal puncture in BMV"],
    ["TIMI", "Thrombolysis in MI (flow grade)",  "0=no flow; 3=normal; target after PCI = TIMI 3"],
    ["TOF",  "Tetralogy of Fallot",              "4 defects: VSD, PS, RVH, overriding aorta"],
    ["TPM",  "Temporary Pacemaker",              "Emergency pacing via transvenous catheter"],
    ["UA",   "Unstable Angina",                  "Part of ACS; troponin negative"],
    ["VSD",  "Ventricular Septal Defect",        "L-to-R shunt; O2 step-up at RV level"],
    ["WPW",  "Wolff-Parkinson-White syndrome",   "Accessory pathway; delta wave on ECG; RF ablation curative"],
    ["XB",   "Extra Backup (guide catheter)",    "For complex LCA interventions needing support"],
]

story.append(make_table(abbr_data,
    col_widths=[3*cm, 5.5*cm, 8.5*cm],
    header_color=DARK_BLUE
))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 2 – KEY DEFINITIONS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 2 — KEY DEFINITIONS", sec_head))
story.append(Spacer(1, 4))

defs = [
    ("Cardiac Catheterization",
     "Insertion of a flexible catheter into the heart chambers or great vessels via a peripheral artery or vein, "
     "to measure pressures, obtain blood samples for oxygen saturation, and inject contrast for angiography."),
    ("Coronary Angiography (CAG)",
     "Radiographic visualization of the coronary arteries by injecting iodinated contrast through a selectively "
     "placed catheter. The gold standard for detecting coronary artery disease."),
    ("PTCA / PCI",
     "Percutaneous Transluminal Coronary Angioplasty / Percutaneous Coronary Intervention: "
     "Balloon dilation of a coronary stenosis, usually followed by stent deployment, performed via arterial access."),
    ("Stent",
     "A metallic mesh scaffold deployed inside a coronary artery to maintain patency after balloon dilation. "
     "Bare metal stents (BMS) and drug-eluting stents (DES) are the two main types."),
    ("Ejection Fraction (EF)",
     "The percentage of blood ejected from the LV with each beat. EF = (EDV - ESV) / EDV × 100. "
     "Normal LVEF is >55%. EF <35% indicates severe LV dysfunction."),
    ("Cardiac Output (CO)",
     "Volume of blood pumped by the heart per minute. CO = HR × SV. Normal: 4–8 L/min. "
     "Measured by thermodilution (Swan-Ganz) or Fick method."),
    ("Cardiac Index (CI)",
     "Cardiac output indexed to body surface area. CI = CO / BSA. Normal: 2.4–4.0 L/min/m². "
     "A better indicator of cardiac function than CO alone."),
    ("Fick Principle",
     "Oxygen consumed by the body = cardiac output × arteriovenous oxygen content difference. "
     "Used to calculate CO: CO = VO2 / (CaO2 - CvO2)."),
    ("Thermodilution",
     "Technique to measure CO using a Swan-Ganz catheter. Cold saline injected into RA; "
     "thermistor in PA measures temperature change. Area under the temperature-time curve is inversely proportional to CO."),
    ("Pulmonary Capillary Wedge Pressure (PCWP)",
     "Balloon-tipped catheter (Swan-Ganz) is advanced until it 'wedges' in a small PA branch, "
     "reflecting left atrial pressure. Normal: 6–12 mmHg. Elevated in LV failure and mitral stenosis."),
    ("Pulmonary Vascular Resistance (PVR)",
     "Resistance to blood flow through pulmonary circulation. "
     "PVR = (Mean PA pressure - PCWP) / CO × 80. Normal <3 Wood units. "
     "Elevated PVR indicates pulmonary arterial hypertension."),
    ("Seldinger Technique",
     "Standard technique for vascular access: puncture artery/vein with needle → pass guidewire → "
     "remove needle → dilate → insert sheath over wire → remove wire → catheter through sheath."),
    ("Pressure Gradient",
     "Difference in pressure across a valve or obstruction. Indicates stenosis severity. "
     "Measured as peak-to-peak (not simultaneous) or mean gradient (more accurate, by planimetry)."),
    ("Damping",
     "Reduction of oscillations in a pressure waveform. Overdamping (air bubble/clot) causes falsely low systolic "
     "and high diastolic readings. Underdamping causes overshoot and falsely elevated systolic readings."),
    ("Optimal damping",
     "Assessed by fast-flush (square wave) test: release of flush should return to baseline in 1–2 oscillations. "
     "Indicates accurate pressure waveform recording."),
    ("No Reflow",
     "Absent or severely diminished antegrade flow (TIMI 0-1) in a coronary artery despite successful "
     "mechanical opening, in the absence of dissection, spasm, or thrombosis. Caused by microvascular injury."),
    ("Contrast Nephropathy (CIN)",
     "Acute kidney injury (creatinine rise >0.5 mg/dL or >25% from baseline) within 48–72 hours after "
     "intravascular contrast administration. Main risk factor: pre-existing CKD."),
    ("Transseptal Puncture",
     "Technique to access the left atrium from the right atrium by puncturing the interatrial septum at "
     "the fossa ovalis using a Brockenbrough needle and Mullins sheath. Essential for BMV and LA procedures."),
    ("Wilkins Score",
     "Echocardiographic scoring system to assess suitability for BMV in mitral stenosis. "
     "Evaluates: leaflet mobility, thickness, calcification, and subvalvular apparatus (each 1–4). "
     "Score ≤8 = good candidate for BMV."),
    ("Counterpulsation (IABP)",
     "Mechanical cardiac support: balloon inflates in diastole (increases coronary perfusion) and deflates "
     "before systole (reduces afterload). Net effect: improved myocardial O2 supply and reduced demand."),
    ("Stent Thrombosis",
     "Thrombotic occlusion of a stented artery. Acute (<24 hrs), subacute (1–30 days), late (1–12 months), "
     "very late (>1 year). Most common cause: premature antiplatelet therapy discontinuation. Mortality 20–40%."),
    ("Coronary Perforation (Ellis Classification)",
     "Class I: extraluminal crater, no extravasation. Class II: myocardial/pericardial blush. "
     "Class III: frank jet of contrast into pericardium — risk of cardiac tamponade; requires covered stent or surgery."),
    ("Qp:Qs Ratio",
     "Ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). Normal = 1:1. "
     ">2:1 indicates significant left-to-right shunt requiring intervention. "
     "Calculated from oxygen saturations at RA, RV, PA, and aorta."),
    ("TIMI Flow Grades",
     "0: No flow. 1: Penetration with minimal perfusion. 2: Partial flow (slower than normal). "
     "3: Full normal flow. Target after primary PCI: TIMI 3."),
    ("French (Fr) Size",
     "Unit of catheter external diameter. 1 Fr = 0.33 mm. Diagnostic catheters: 5–6 Fr. "
     "Guiding catheters: 6–8 Fr. Larger Fr = larger catheter bore."),
    ("Radiofrequency Ablation",
     "Delivery of radiofrequency energy (300–750 kHz) via ablation catheter to create resistive "
     "heating (50–60°C) and irreversible thermal injury to arrhythmogenic tissue."),
    ("Oxygen Step-Up",
     "Significant rise in blood oxygen saturation at a cardiac chamber during right heart catheterization, "
     "indicating left-to-right shunting at that level. RA step-up (>7% above SVC) = ASD; RV (>5% above RA) = VSD; "
     "PA (>5% above RV) = PDA."),
    ("Ventricular Function Assessment (LVG)",
     "Left ventriculography using pigtail catheter and power injector (30–40 mL at 10–15 mL/sec). "
     "Views: RAO 30° (anterior/inferior walls) and LAO 60° (septum/posterior). "
     "Assesses LVEF, RWMA, and mitral regurgitation."),
    ("Ionic vs Non-ionic Contrast",
     "Ionic: high osmolarity (~1500–2000 mOsm/kg), more side effects, cheaper. "
     "Non-ionic: low osmolarity (~500–900 mOsm/kg), safer. Iodixanol is iso-osmolar (290 mOsm/kg) - "
     "preferred in CKD patients."),
    ("Aortic Regurgitation Grading",
     "1+: Faint reflux, clears each beat. 2+: Partial LV opacification. "
     "3+: Complete LV = aortic density. 4+: Dense LV opacification > aorta on first beat."),
]

for term, definition in defs:
    keep_items = [
        Paragraph(f"<font color='#0D2B6B'><b>{term}</b></font>", body_bold),
        Paragraph(definition, body),
        Spacer(1, 3),
    ]
    story.append(KeepTogether(keep_items))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 3 – NORMAL VALUES
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 3 — NORMAL HEMODYNAMIC VALUES", sec_head))
story.append(Spacer(1, 4))

nv_data = [
    ["Parameter", "Normal Value", "Clinical Notes"],
    ["Right Atrial (RA) pressure",     "Mean 2–8 mmHg",              "Elevated in RV failure, tamponade"],
    ["Right Ventricular (RV) pressure","Systolic 15–30 / Diastolic 0–8 mmHg","Elevated systolic in pulm. HTN"],
    ["Pulmonary Artery (PA) pressure", "Systolic 15–30 / Diastolic 4–12 mmHg","Mean PAP >25 = pulmonary HTN"],
    ["PCWP (Wedge pressure)",          "Mean 6–12 mmHg",             ">18 = LV failure or MS"],
    ["Left Atrial (LA) pressure",      "Mean 6–12 mmHg",             "Directly measured during BMV"],
    ["LV systolic pressure",           "90–140 mmHg",                "Gradient with aorta indicates AS"],
    ["LV diastolic pressure (LVEDP)",  "4–12 mmHg",                  ">20 = significant LV dysfunction"],
    ["Aortic pressure",                "Systolic 90–140 / Diastolic 60–90 mmHg","Mean 70–105 mmHg"],
    ["Cardiac Output (CO)",            "4–8 L/min",                  "Measured by Fick or thermodilution"],
    ["Cardiac Index (CI)",             "2.4–4.0 L/min/m²",           "<2.2 = cardiogenic shock"],
    ["Pulmonary Vascular Resistance",  "<3 Wood units / <250 dynes·s·cm⁻⁵","Elevated in pulm. arterial HTN"],
    ["Systemic Vascular Resistance",   "800–1500 dynes·s·cm⁻⁵",     "Reduced in septic shock"],
    ["O2 saturation — Aorta/PA",       "Aorta >95% / PA 65–75%",    "Step-up in PA level = PDA"],
    ["Aortic Valve Area (AVA)",        "2.5–3.5 cm²",                "Severe AS: <1.0 cm²; critical <0.6 cm²"],
    ["Mitral Valve Area (MVA)",        "4–6 cm²",                    "Severe MS: <1.0 cm²; BMV: <1.5 cm²"],
    ["LVEF",                           ">55%",                       "Mild dysfn 41–54%; Severe <35%"],
    ["HV interval",                    "35–55 ms",                   ">70 ms = risk of complete AV block"],
    ["AH interval",                    "55–130 ms",                  "Prolonged in AV nodal disease"],
]
story.append(make_table(nv_data, col_widths=[5.5*cm, 5*cm, 6.5*cm], header_color=GREEN))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 4 – CATHETERS AT A GLANCE
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 4 — CATHETER QUICK REFERENCE", sec_head))
story.append(Spacer(1, 4))

cath_data = [
    ["Catheter", "Type", "Used For"],
    ["Judkins Left (JL 3.5, 4.0, 5.0)", "Diagnostic", "Left coronary artery angiography"],
    ["Judkins Right (JR 4.0)",           "Diagnostic", "Right coronary artery angiography"],
    ["Pigtail",                           "Diagnostic", "LV angiography, aortography"],
    ["Multipurpose A (MPA)",              "Diagnostic", "RHC, saphenous vein graft angiography"],
    ["Amplatz Left (AL)",                 "Diagnostic", "LCA in tortuous aortic root; horizontal heart"],
    ["Amplatz Right (AR)",                "Diagnostic", "RCA, SVG, anomalous coronaries"],
    ["NIH catheter",                      "Diagnostic", "Right heart catheterization"],
    ["Berman (balloon-tipped)",           "Diagnostic", "PA catheterization in CHD"],
    ["Swan-Ganz",                         "Diagnostic/monitoring", "PA pressure, PCWP, thermodilution CO"],
    ["Judkins Guide (JL/JR-guide)",       "Guiding", "Standard PCI guide catheter"],
    ["XB / EBU guide",                    "Guiding", "LCA PCI requiring extra backup support"],
    ["Brockenbrough needle",              "Special", "Transseptal puncture for LA access (BMV/AF ablation)"],
    ["Inoue balloon",                     "Intervention", "Balloon mitral valvuloplasty"],
    ["Quadripolar EP catheter",           "EP study", "His bundle, RV recordings in EPS"],
    ["Decapolar EP catheter",             "EP study", "Coronary sinus mapping in EPS"],
    ["IABP catheter (7–8 Fr)",            "Support", "Intra-aortic counterpulsation"],
]
story.append(make_table(cath_data, col_widths=[5.5*cm, 3.5*cm, 8*cm], header_color=MED_BLUE))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 5 – STERILIZATION COMPARISON
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 5 — STERILIZATION METHODS COMPARISON", sec_head))
story.append(Spacer(1, 4))

ster_data = [
    ["Method", "Temp/Conditions", "Time", "Best For", "Key Drawback"],
    ["Autoclave (Steam)", "121°C, 15 psi", "15–30 min", "Metal instruments, glass", "Damages heat-sensitive items"],
    ["Ethylene Oxide (EtO)", "55°C gas", "2–6 hrs + 8–12 hr aeration", "Catheters, electronics", "Toxic; long aeration time"],
    ["Glutaraldehyde 2%", "Room temp", "20 min (disinfection)\n10 hrs (sterilization)", "Flexible scopes, catheters", "Toxic fumes; must rinse thoroughly"],
    ["H2O2 Plasma (Sterrad)", "Low temp", "28–75 min", "Heat/moisture-sensitive items", "Cannot use with cellulose items; costly"],
    ["Dry Heat", "160–170°C", "1–2 hrs", "Glassware, powders, oils", "Damages rubber/plastic"],
    ["Gamma Radiation", "Cobalt-60", "Factory use only", "Disposable catheters", "Not available in hospitals"],
]
story.append(make_table(ster_data,
    col_widths=[3.5*cm, 3.5*cm, 2.5*cm, 4*cm, 3.5*cm],
    header_color=ORANGE))
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 6 – FLUOROSCOPY VIEWS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 6 — STANDARD FLUOROSCOPY VIEWS", sec_head))
story.append(Spacer(1, 4))

views_data = [
    ["View", "Angulation", "Best Visualizes"],
    ["LAO 45° Cranial",  "Left 45° + head 25°", "Left main, LAD, proximal diagonal branches"],
    ["RAO 30° Cranial",  "Right 30° + head 25°", "LAD mid/distal, diagonal branches"],
    ["LAO 45° Caudal (Spider)", "Left 45° + feet 25°", "Left main bifurcation, LCX, first obtuse marginal"],
    ["RAO 30° Caudal",   "Right 30° + feet 25°", "LCX, obtuse marginal branches"],
    ["AP Cranial",       "Straight + head 25°", "LAD, septal perforators, left main"],
    ["LAO 45°",          "Left 45°, no tilt", "RCA mid/distal, posterior descending"],
    ["RAO 30°",          "Right 30°, no tilt", "LV wall motion (LVG standard view)"],
    ["LAO 60° (Cranial)","Left 60° + head 20°", "LV septum (LVG)"],
    ["AP / Lateral",     "0° / 90°", "Abdominal aorta, pacemaker lead position"],
]
story.append(make_table(views_data, col_widths=[4*cm, 4*cm, 9*cm], header_color=DARK_BLUE))
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 7 – PACEMAKER CODES
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 7 — PACEMAKER NBG CODE QUICK GUIDE", sec_head))
story.append(Spacer(1, 4))

pm_data = [
    ["Position", "Meaning", "Letters Used"],
    ["1st letter", "Chamber PACED",   "A = Atrium, V = Ventricle, D = Dual (both)"],
    ["2nd letter", "Chamber SENSED",  "A = Atrium, V = Ventricle, D = Dual, O = None"],
    ["3rd letter", "Response to sensing", "I = Inhibit, T = Trigger, D = Dual, O = None"],
    ["4th letter", "Rate modulation", "R = Rate-responsive sensor; O = None"],
]
pm_modes = [
    ["Mode", "Full Name", "Indication"],
    ["VVI",  "Ventricle paced, sensed, inhibited",              "Atrial fibrillation with bradycardia"],
    ["AAI",  "Atrium paced, sensed, inhibited",                 "Sick sinus syndrome with intact AV conduction"],
    ["DDD",  "Both chambers paced, sensed, dual response",      "Complete AV block with sinus rhythm (most physiologic)"],
    ["VVIR", "VVI + rate responsive",                           "AF with bradycardia; patient active"],
    ["DDDR", "DDD + rate responsive",                           "Complete AV block + chronotropic incompetence"],
]
story.append(make_table(pm_data,   col_widths=[3*cm, 4*cm, 10*cm], header_color=MED_BLUE))
story.append(Spacer(1, 4))
story.append(Paragraph("Common Pacing Modes:", sub_head))
story.append(make_table(pm_modes,  col_widths=[2*cm, 7*cm, 8*cm], header_color=GREEN))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 8 – KEY FORMULAS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 8 — IMPORTANT FORMULAS & CALCULATIONS", sec_head))
story.append(Spacer(1, 4))

formulas = [
    ("Ejection Fraction (EF)",
     "EF (%) = [(EDV - ESV) / EDV] × 100\nNormal: >55%  |  Severe dysfunction: <35%"),
    ("Cardiac Output (CO)",
     "CO (L/min) = Heart Rate × Stroke Volume\nNormal: 4–8 L/min"),
    ("Cardiac Index (CI)",
     "CI = CO / Body Surface Area (BSA)\nNormal: 2.4–4.0 L/min/m²"),
    ("Fick Method for CO",
     "CO = O2 Consumption (mL/min) / [Arterial O2 content - Venous O2 content] (mL/L)\nO2 Content = Hb × 1.34 × SaO2 × 10"),
    ("Pulmonary Vascular Resistance (PVR)",
     "PVR = [(Mean PA pressure - PCWP) / CO] × 80\nNormal: <3 Wood units  |  <250 dynes·s·cm-5"),
    ("Systemic Vascular Resistance (SVR)",
     "SVR = [(Mean Aortic pressure - RA pressure) / CO] × 80\nNormal: 800–1500 dynes·s·cm-5"),
    ("Qp:Qs (Shunt Ratio)",
     "Qp:Qs = (Aortic O2 sat - Mixed Venous O2 sat) / (Pulmonary Vein O2 sat - PA O2 sat)\nNormal: 1:1  |  >2:1 = significant L-to-R shunt"),
    ("Contrast Volume Limit (CIN prevention)",
     "Maximum contrast volume = 3.7 × eGFR (mL)\nIdeal: keep total <100 mL in at-risk patients"),
    ("Heparin Dosing for PCI",
     "Initial bolus: 70–100 U/kg IV\nACT target during PCI: 250–300 seconds\nReduce to 50–75 U/kg if GP IIb/IIIa used"),
    ("Pacemaker Threshold",
     "Implant threshold target: <1.0 V at 0.5 ms pulse width\nProgrammed output: 2× threshold (safety margin)"),
]

for i, (title, formula) in enumerate(formulas):
    bg = LIGHT_BLUE if i % 2 == 0 else LIGHT_GREEN
    border = MED_BLUE if i % 2 == 0 else GREEN
    box = Table(
        [[Paragraph(f"<b><font color='#0D2B6B'>{title}</font></b>", body_bold)],
         [Paragraph(formula.replace("\n", "<br/>"), body)]],
        colWidths=[W],
        style=TableStyle([
            ("BACKGROUND",   (0,0), (-1,-1), bg),
            ("BOX",          (0,0), (-1,-1), 1.2, border),
            ("LEFTPADDING",  (0,0), (-1,-1), 8),
            ("RIGHTPADDING", (0,0), (-1,-1), 8),
            ("TOPPADDING",   (0,0), (-1,-1), 5),
            ("BOTTOMPADDING",(0,0), (-1,-1), 5),
        ])
    )
    story.append(box)
    story.append(Spacer(1, 4))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 9 – HIGH-YIELD EXAM FACTS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 9 — HIGH-YIELD EXAM FACTS  ★", sec_head))
story.append(Spacer(1, 4))

facts = [
    ("★ Gold standard for coronary artery disease", "Coronary Angiography (CAG)"),
    ("★ Gold standard for hemodynamics / CO", "Fick Method"),
    ("★ Most physiologic pacing mode", "DDD (or DDDR)"),
    ("★ Catheter for LV angiography", "Pigtail catheter"),
    ("★ Catheter for RCA angiography", "Judkins Right 4.0 (JR 4.0)"),
    ("★ Standard 0.014\" guidewire", "BMW (Balance Middle Weight)"),
    ("★ Contrast agent for CKD patients", "Iodixanol (Visipaque) — iso-osmolar"),
    ("★ Transseptal puncture site", "Fossa ovalis of interatrial septum"),
    ("★ PCWP reflects", "Left atrial pressure (indirect)"),
    ("★ No reflow treatment (first line)", "Intracoronary adenosine / sodium nitroprusside"),
    ("★ Most common cause of stent thrombosis (clinical)", "Premature antiplatelet therapy discontinuation"),
    ("★ Most common mechanical cause of stent thrombosis", "Stent underexpansion"),
    ("★ Ellis Class III perforation management", "Balloon tamponade → covered stent → pericardiocentesis if tamponade"),
    ("★ IABP position on CXR", "2–3 cm distal to left subclavian artery origin (at carina level)"),
    ("★ IABP timing: inflates at", "Dicrotic notch (aortic valve closure) = onset of diastole"),
    ("★ BMV: best candidate (Wilkins score)", "Score ≤8 (max 16); pliable, non-calcified valve"),
    ("★ Severe aortic stenosis criteria", "AVA <1.0 cm² AND mean gradient >40 mmHg"),
    ("★ Severe mitral stenosis criteria", "MVA <1.0 cm² (by catheterization) or <1.5 cm² (by echo)"),
    ("★ O2 step-up at RA level indicates", "ASD (Atrial Septal Defect) — >7% above SVC"),
    ("★ O2 step-up at RV level indicates", "VSD (Ventricular Septal Defect) — >5% above RA"),
    ("★ O2 step-up at PA level indicates", "PDA (Patent Ductus Arteriosus) — >5% above RV"),
    ("★ HV interval >70 ms (prolonged) indicates", "Infra-His disease; risk of complete AV block"),
    ("★ Sterilization for catheters (hospital)", "Ethylene oxide (EtO) gas or Sterrad (H2O2 plasma)"),
    ("★ Fast-flush test (square wave) assesses", "Pressure system damping characteristics"),
    ("★ Thermodilution CO: unreliable in", "Significant tricuspid regurgitation, low output states"),
    ("★ Pigtail injection for LVG", "30–40 mL at 10–15 mL/sec via power injector"),
    ("★ Coronary perfusion is maximum during", "Diastole (hence IABP inflation during diastole)"),
    ("★ Protamine reverses", "Heparin anticoagulation"),
    ("★ TIMI 3 flow means", "Full antegrade flow, same as normal coronary artery"),
    ("★ Guiding catheter size for PCI", "6–8 French (larger bore than diagnostic 5–6 Fr)"),
]

fact_data = [["Topic", "Key Answer / Fact"]]
for topic, answer in facts:
    fact_data.append([topic, answer])

story.append(make_table(fact_data,
    col_widths=[8*cm, 9*cm],
    header_color=ACCENT))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 10 – COMPLICATIONS SUMMARY
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("  SECTION 10 — COMPLICATIONS & MANAGEMENT SUMMARY", sec_head))
story.append(Spacer(1, 4))

comp_data = [
    ["Complication", "Mechanism", "Management"],
    ["No Reflow",      "Distal embolization, microvascular spasm",
     "IC adenosine 100–300 mcg\nIC nitroprusside 100–300 mcg\nIC verapamil 100–300 mcg"],
    ["Acute Stent Thrombosis",  "Underexpansion, antiplatelet failure",
     "Emergency PCI + thrombus aspiration\nPrasugrel 60 mg or Ticagrelor 180 mg\nGP IIb/IIIa inhibitor"],
    ["Coronary Perforation (III)", "Wire/balloon through vessel wall",
     "Balloon tamponade → Covered stent\nProtamine (reverse heparin)\nPericardiocentesis if tamponade"],
    ["Contrast Nephropathy",   "Tubular toxicity, vasoconstriction",
     "IV saline hydration (1 mL/kg/hr)\nUse iodixanol\nMinimize contrast volume"],
    ["Coronary Dissection",    "Intimal tear during PCI",
     "Stent to seal entry tear\nCovered stent for extensive dissection\nEmergency CABG if surgery needed"],
    ["Cardiac Tamponade",      "Pericardial fluid compression",
     "Emergency pericardiocentesis\nIV fluids, avoid vasodilators\nSurgery if bleeding continues"],
    ["Overdamping (pressure)", "Air bubble, clot, kinked catheter",
     "Fast-flush, aspirate catheter\nRemove air bubbles\nReprime system"],
    ["IABP limb ischemia",     "Femoral artery obstruction by catheter",
     "Remove IABP or upsize access\nAnticoagulation\nVascular surgery if needed"],
]

comp_tbl = Table(comp_data,
    colWidths=[3.5*cm, 5*cm, 8.5*cm],
    style=TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), ACCENT),
        ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
        ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 8.5),
        ("ALIGN",         (0,0), (-1,0), "CENTER"),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_BG]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.grey),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("RIGHTPADDING",  (0,0), (-1,-1), 5),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ])
)
story.append(comp_tbl)
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════════════════════
# FINAL TIP BOX
# ═══════════════════════════════════════════════════════════════════════════════
tip_box = Table(
    [[Paragraph("<b>EXAM TIPS</b>", S("T", fontName="Helvetica-Bold", fontSize=11, textColor=DARK_BLUE))],
     [Paragraph(
         "• Long essays (15 marks): Coronary angiography, PTCA hardware, cardiac output methods, IABP<br/>"
         "• Short essays (10 marks): Contrast nephropathy, BMV technique, pacemaker modes, RHC<br/>"
         "• Short answers (5 marks): Thermodilution, transseptal puncture, stent types, O2 step-up, no-reflow<br/>"
         "• Always include <b>normal values</b> in pressure-related answers<br/>"
         "• Mention <b>complications and management</b> in procedure-based questions<br/>"
         "• For sterilization: know advantages AND disadvantages of each method",
         body
     )]],
    colWidths=[W],
    style=TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), YELLOW_BG),
        ("BOX",          (0,0), (-1,-1), 2, ORANGE),
        ("LEFTPADDING",  (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING",   (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0), (-1,-1), 6),
    ])
)
story.append(tip_box)

# ── Build ─────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF created: {OUTPUT}")

cd /home/daytona/workspace/cardiac-tech-study && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/cardiac-tech-study/