from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT
from docx.oxml.ns import qn
from docx.oxml import OxmlElement

doc = Document()

style = doc.styles["Normal"]
style.font.name = "Arial"
style.font.size = Pt(11)

NAVY = RGBColor(0x1F, 0x3B, 0x57)
RED = RGBColor(0xB0, 0x20, 0x20)
GREY = RGBColor(0x55, 0x55, 0x55)

def shade_cell(cell, hex_color):
    tcPr = cell._tc.get_or_add_tcPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), hex_color)
    tcPr.append(shd)

def set_cell_text(cell, text, bold=False, color=None, size=10, align=None):
    cell.text = ""
    p = cell.paragraphs[0]
    if align:
        p.alignment = align
    run = p.add_run(text)
    run.bold = bold
    run.font.size = Pt(size)
    if color:
        run.font.color.rgb = color

# Title
title = doc.add_heading("Quick Reference Guide", level=0)
title.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub = doc.add_paragraph()
sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
r = sub.add_run("Acute Pulmonary Edema and Tachycardia-Induced Cardiomyopathy")
r.bold = True
r.font.size = Pt(15)
r.font.color.rgb = NAVY

note = doc.add_paragraph()
note.alignment = WD_ALIGN_PARAGRAPH.CENTER
rn = note.add_run("For clinician educational reference. Always individualize therapy to hemodynamic status, etiology, and local protocols.")
rn.italic = True
rn.font.size = Pt(9)
rn.font.color.rgb = GREY

doc.add_paragraph()

# ============ SECTION 1: ACUTE PULMONARY EDEMA ============
h1 = doc.add_heading("1. Acute Pulmonary Edema", level=1)
for run in h1.runs:
    run.font.color.rgb = NAVY

doc.add_paragraph(
    "Most commonly cardiogenic (acute decompensated heart failure, precipitated by ischemia, "
    "arrhythmia, hypertensive crisis, or valvular disease). Can also be non-cardiogenic "
    "(ARDS, high-altitude, neurogenic, renal volume overload)."
)

h2 = doc.add_heading("1.1 Immediate Stabilization (ABCs)", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY
bullets = [
    "Position: sit upright, legs dependent, to reduce venous return and improve ventilation.",
    "Oxygen: supplemental O2 to maintain SpO2 90-94%.",
    "Non-invasive ventilation (NIV) - CPAP or bilevel (BiPAP): first-line respiratory support in most patients with respiratory distress; reduces preload/afterload and work of breathing, lowers intubation rates. No significant outcome difference between CPAP and bilevel (Fishman's Pulmonary Diseases and Disorders, p. 3533-3535).",
    "Intubation/mechanical ventilation if respiratory failure, altered mental status, or NIV failure.",
    "Continuous cardiac monitoring, IV access; identify and treat the precipitant in parallel."
]
for b in bullets:
    doc.add_paragraph(b, style="List Bullet")

h2 = doc.add_heading("1.2 Pharmacologic Therapy (Guided by Blood Pressure)", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY

table = doc.add_table(rows=1, cols=3)
table.style = "Light Grid Accent 1"
table.alignment = WD_TABLE_ALIGNMENT.CENTER
hdr = table.rows[0].cells
set_cell_text(hdr[0], "Agent Class", bold=True, color=RGBColor(0xFF,0xFF,0xFF))
set_cell_text(hdr[1], "Role / Dosing Notes", bold=True, color=RGBColor(0xFF,0xFF,0xFF))
set_cell_text(hdr[2], "Key Cautions", bold=True, color=RGBColor(0xFF,0xFF,0xFF))
for c in hdr:
    shade_cell(c, "1F3B57")

rows_data = [
    ("Loop diuretics (IV furosemide)",
     "Mainstay of therapy. IV furosemide causes direct venodilation (reduces preload) within minutes, before diuresis begins; reduces LV filling pressures and pulmonary congestion.",
     "Use together with a vasodilator in normotensive/hypertensive patients - diuretic-induced natriuresis alone can transiently raise afterload."),
    ("Nitrates (IV nitroglycerin)",
     "Preload and afterload reduction; improves coronary blood flow, reduces myocardial O2 demand. Typical start 5-10 mcg/min IV, titrate to effect.",
     "Avoid/caution in hypotension, severe aortic stenosis, recent PDE5-inhibitor use."),
    ("Morphine",
     "Historically for anxiolysis and mild venodilation.",
     "No longer first-line - associated with increased mortality/intubation in observational data; reserve for select cases of severe anxiety/pain."),
    ("Inotropes / vasopressors (dobutamine, milrinone, norepinephrine)",
     "For hypotensive patients or cardiogenic shock; supports perfusion when diuretics/nitrates are contraindicated.",
     "Consider mechanical circulatory support (IABP, ECMO) if refractory shock."),
]
for a, b, c in rows_data:
    row = table.add_row().cells
    set_cell_text(row[0], a, bold=True, size=10)
    set_cell_text(row[1], b, size=10)
    set_cell_text(row[2], c, size=10, color=RED)

doc.add_paragraph()

h2 = doc.add_heading("1.3 Treat the Underlying Precipitant", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY
bullets2 = [
    "Acute coronary syndrome -> urgent reperfusion.",
    "Hypertensive emergency -> aggressive IV BP control.",
    "Tachy/bradyarrhythmia -> rate/rhythm control or pacing (see Section 2 for tachycardia-driven cases).",
    "Acute valvular emergency (e.g., acute MR/AR) -> urgent surgical evaluation.",
    "Volume overload from renal failure -> consider ultrafiltration/dialysis if diuretic-refractory."
]
for b in bullets2:
    doc.add_paragraph(b, style="List Bullet")

h2 = doc.add_heading("1.4 Non-Cardiogenic Pulmonary Edema", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY
doc.add_paragraph(
    "Diuretics/nitrates are far less effective (problem is capillary leak, not hydrostatic pressure). "
    "Management shifts to lung-protective ventilation, treating the underlying cause (sepsis, transfusion "
    "reaction), and conservative fluid management."
)

doc.add_page_break()

# ============ SECTION 2: TACHYCARDIA-INDUCED CARDIOMYOPATHY ============
h1 = doc.add_heading("2. Tachycardia-Induced Cardiomyopathy (Tachycardiomyopathy)", level=1)
for run in h1.runs:
    run.font.color.rgb = NAVY

h2 = doc.add_heading("2.1 Definition and Key Features", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY
bullets3 = [
    "Prolonged tachycardia causes diastolic and systolic LV dysfunction, even without other structural heart disease.",
    "Diagnosis is retrospective: confirmed when correction of the arrhythmia is followed by improved ventricular function.",
    "Consider in any patient with tachycardia and LV systolic dysfunction who is not in sinus rhythm.",
    "May occur as an isolated condition or superimposed on pre-existing cardiomyopathy (e.g., worsens a patient with mild DCM who develops AF).",
    "\"Purest\" form: incessant/very frequent atrial tachycardia or permanent junctional reciprocating tachycardia (often young patients).",
    "Almost any sustained arrhythmia can cause it - includes very frequent PVCs (typically >20,000/24h) or recurrent nonsustained VT.",
    "Duration of arrhythmia (not just heart rate) is the critical driver - mean symptom duration in one series was 6 years with a mean ventricular response of only 117 bpm.",
    "Always rule out hyperthyroidism, which can independently cause tachycardia and (rarely) its own dilated cardiomyopathy.",
]
for b in bullets3:
    doc.add_paragraph(b, style="List Bullet")
doc.add_paragraph("Source: Braunwald's Heart Disease, p. 1398-1406.", style="Intense Quote")

h2 = doc.add_heading("2.2 Treatment Principles", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY

table2 = doc.add_table(rows=1, cols=2)
table2.style = "Light Grid Accent 1"
hdr2 = table2.rows[0].cells
set_cell_text(hdr2[0], "Strategy", bold=True, color=RGBColor(0xFF,0xFF,0xFF))
set_cell_text(hdr2[1], "Details", bold=True, color=RGBColor(0xFF,0xFF,0xFF))
for c in hdr2:
    shade_cell(c, "1F3B57")

rows2 = [
    ("Definitive treatment = eliminate the tachycardia",
     "Correcting the causal arrhythmia is the only treatment that reverses the cardiomyopathy. Rate or rhythm control is the goal, not just symptom control."),
    ("Rate control",
     "Beta-blockers, non-dihydropyridine calcium channel blockers (verapamil/diltiazem), or digoxin to slow AV nodal conduction (e.g., in atrial fibrillation)."),
    ("Rhythm control",
     "Antiarrhythmic drugs or cardioversion to restore sinus rhythm when feasible, especially if the patient remains symptomatic on rate control."),
    ("Catheter ablation",
     "Preferred, often curative, for incessant atrial tachycardia, AVNRT/AVRT, atrial flutter, and frequent PVC-induced cardiomyopathy. Ablation of PVCs is generally associated with improvement in ventricular function."),
    ("Anticoagulation",
     "If atrial fibrillation/flutter is the cause, assess thromboembolic risk (e.g., CHA2DS2-VASc) and anticoagulate accordingly (DOAC preferred over warfarin in most nonvalvular AF)."),
    ("Guideline-directed HF therapy",
     "Continue standard heart failure medical therapy (ACE-I/ARB/ARNI, beta-blocker, MRA, SGLT2i as tolerated) while the arrhythmia is being treated, since systolic dysfunction is present."),
    ("Acute presentation with pulmonary edema / cardiogenic shock",
     "Urgent rate or rhythm control (including electrical cardioversion) is the priority intervention - reversal of severe tachycardia-induced cardiomyopathy with cardiogenic shock has been achieved specifically through urgent rhythm/rate control. Combine with supportive pulmonary edema care from Section 1 (oxygen/NIV, cautious diuresis, hemodynamic support) while arrhythmia treatment is arranged."),
]
for a, b in rows2:
    row = table2.add_row().cells
    set_cell_text(row[0], a, bold=True, size=10)
    set_cell_text(row[1], b, size=10)

doc.add_paragraph()

h2 = doc.add_heading("2.3 Monitoring and Prognosis", level=2)
for run in h2.runs:
    run.font.color.rgb = NAVY
bullets4 = [
    "Most cases improve within 3-6 months after arrhythmia correction; occasional late improvement up to 1 year.",
    "Reassess ejection fraction early after restoration of sinus rhythm, then again at 3-6 months (beat-to-beat EF variability in AF makes a single early reading unreliable).",
    "Mild LV dilation or subtle dysfunction may persist even after EF normalizes; recurrence of the arrhythmia can cause deterioration again, so long-term rhythm/rate surveillance is needed.",
    "Use 24-hour ambulatory monitoring to confirm adequate rate control during both activity and rest, not just at a single clinic visit."
]
for b in bullets4:
    doc.add_paragraph(b, style="List Bullet")
doc.add_paragraph("Source: Braunwald's Heart Disease, p. 1400-1406; The Washington Manual of Medical Therapeutics, p. 2093-2119.", style="Intense Quote")

doc.add_page_break()

# ============ SECTION 3: INTEGRATED APPROACH ============
h1 = doc.add_heading("3. Integrated Approach When Both Overlap", level=1)
for run in h1.runs:
    run.font.color.rgb = NAVY
doc.add_paragraph(
    "A patient can present in acute pulmonary edema caused by an incessant tachyarrhythmia that has "
    "produced tachycardia-induced cardiomyopathy. In this scenario:"
)
bullets5 = [
    "Stabilize first: oxygen/NIV, positioning, IV access, monitoring (Section 1.1).",
    "Identify the rhythm: 12-lead ECG; compare to prior ECGs since incessant atrial tachycardia can mimic sinus tachycardia.",
    "Treat the pulmonary edema supportively (cautious diuretic/nitrate use per hemodynamics), but recognize that symptomatic relief will be limited until the tachycardia itself is controlled.",
    "Pursue urgent rate or rhythm control (pharmacologic or electrical cardioversion) as the definitive intervention - this is what reverses both the acute decompensation and the underlying cardiomyopathy.",
    "Arrange definitive rhythm therapy (e.g., catheter ablation) once stabilized, since eliminating the arrhythmia is required for full myocardial recovery.",
    "Rule out hyperthyroidism and other reversible contributors during the same workup."
]
for b in bullets5:
    doc.add_paragraph(b, style="List Bullet")

doc.add_paragraph()
foot = doc.add_paragraph()
fr = foot.add_run(
    "Sources: The Washington Manual of Medical Therapeutics; Lippincott Illustrated Reviews - Pharmacology; "
    "Katzung's Basic and Clinical Pharmacology; Barash, Cullen, and Stoelting's Clinical Anesthesia; "
    "Fishman's Pulmonary Diseases and Disorders; Rosen's Emergency Medicine; Goodman & Gilman's The "
    "Pharmacological Basis of Therapeutics; Braunwald's Heart Disease; Harrison's Principles of Internal Medicine 22E."
)
fr.italic = True
fr.font.size = Pt(8)
fr.font.color.rgb = GREY

out_path = "/tmp/workspace/pulmonary-edema-tachycardiomyopathy/output/Acute_Pulmonary_Edema_and_Tachycardiomyopathy_QuickRef.docx"
doc.save(out_path)
print("Saved:", out_path)