const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Pulmonary Hypertension, VTE & Pulmonary Embolism";
pres.author = "General Medicine Residency Presentation";

// ── COLOUR PALETTE ──────────────────────────────────────────────────────────
const C = {
  bg:        "0B1F3A",   // deep navy (dominant)
  bgAlt:     "0E2A50",   // slightly lighter navy
  accent:    "E94F3D",   // strong red-orange (PE/clot accent)
  gold:      "F5A623",   // amber/gold
  teal:      "3AB4BF",   // teal (PH accent)
  white:     "FFFFFF",
  light:     "D6E4F0",
  muted:     "8DAFC4",
  dark:      "061225",
  green:     "2ECC71",
  yellow:    "F7DC6F",
  orange:    "E67E22",
  red:       "C0392B",
};

// ── HELPERS ──────────────────────────────────────────────────────────────────
function titleSlide(slide) {
  slide.background = { color: C.dark };
  // Top accent bar
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.12, fill:{color:C.accent} });
  // Side bar
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.12, w:0.35, h:7.38, fill:{color:C.teal} });
}

function sectionBg(slide, color) {
  slide.background = { color: color || C.bg };
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.1, fill:{color:C.accent} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:7.4, w:13.3, h:0.1, fill:{color:C.teal} });
}

function slideHeader(slide, title, subtitle) {
  sectionBg(slide);
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.1, w:4.2, h:7.4, fill:{color:C.bgAlt} });
  slide.addText(title, {
    x:0.2, y:0.3, w:3.8, h:2.5,
    fontSize:22, bold:true, color:C.white, fontFace:"Calibri",
    align:"left", valign:"top", wrap:true
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x:0.2, y:2.8, w:3.8, h:0.6,
      fontSize:11, color:C.teal, fontFace:"Calibri", align:"left", italic:true
    });
  }
}

function addBullets(slide, items, x, y, w, h, fontSize, color, opts) {
  const base = { fontFace:"Calibri", color: color||C.light, fontSize:fontSize||13 };
  const textArr = items.map((item, i) => {
    const isLast = i === items.length - 1;
    if (typeof item === "object") {
      return { text: item.text, options: { ...base, bullet:{indent:item.indent||0}, fontSize:item.size||fontSize||13, color:item.color||color||C.light, bold:item.bold||false, breakLine: !isLast } };
    }
    return { text: item, options: { ...base, bullet:true, breakLine: !isLast } };
  });
  slide.addText(textArr, { x, y, w, h, valign:"top", ...(opts||{}) });
}

function sectionDivider(pres, sectionNum, title, subtitle, color) {
  const slide = pres.addSlide();
  slide.background = { color: color || C.accent };
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.08, fill:{color:C.dark} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:7.42, w:13.3, h:0.08, fill:{color:C.dark} });
  slide.addText(`SECTION ${sectionNum}`, {
    x:1, y:1.8, w:11.3, h:0.8,
    fontSize:16, color:C.white, fontFace:"Calibri", align:"center", charSpacing:6, opacity:80
  });
  slide.addText(title, {
    x:1, y:2.5, w:11.3, h:1.6,
    fontSize:40, bold:true, color:C.white, fontFace:"Calibri", align:"center"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x:1, y:4.2, w:11.3, h:0.8,
      fontSize:16, color:C.white, fontFace:"Calibri", align:"center", italic:true
    });
  }
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1: TITLE SLIDE
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  titleSlide(slide);
  slide.addShape(pres.ShapeType.rect, { x:0.35, y:1.2, w:12.95, h:0.08, fill:{color:C.gold}, opacity:40 });
  slide.addText("PULMONARY HYPERTENSION,", {
    x:0.6, y:1.4, w:12.0, h:1.1,
    fontSize:36, bold:true, color:C.white, fontFace:"Calibri", align:"left"
  });
  slide.addText("VENOUS THROMBOEMBOLISM", {
    x:0.6, y:2.4, w:12.0, h:1.0,
    fontSize:36, bold:true, color:C.teal, fontFace:"Calibri", align:"left"
  });
  slide.addText("& PULMONARY EMBOLISM", {
    x:0.6, y:3.3, w:12.0, h:1.0,
    fontSize:36, bold:true, color:C.gold, fontFace:"Calibri", align:"left"
  });
  slide.addShape(pres.ShapeType.rect, { x:0.35, y:4.3, w:8, h:0.04, fill:{color:C.muted} });
  slide.addText([
    { text: "Updated with ", options:{color:C.muted} },
    { text: "2026 AHA/ACC Guideline", options:{color:C.gold, bold:true} },
    { text: " | ESC/ERS 2022 PH Guidelines", options:{color:C.muted} }
  ], { x:0.6, y:4.5, w:12.0, h:0.5, fontSize:13, fontFace:"Calibri" });
  slide.addText("Residency Presentation — General Medicine  |  May 2026", {
    x:0.6, y:5.2, w:12.0, h:0.4,
    fontSize:12, color:C.muted, fontFace:"Calibri", italic:true
  });
  // Three coloured tags
  const tags = [
    { label:"Pulmonary Hypertension", col:C.teal },
    { label:"Venous Thromboembolism", col:C.gold },
    { label:"Acute Pulmonary Embolism", col:C.accent },
  ];
  tags.forEach((t,i) => {
    slide.addShape(pres.ShapeType.rect, { x:0.6+i*4.1, y:6.1, w:3.8, h:0.5, fill:{color:t.col}, rounding:true });
    slide.addText(t.label, { x:0.6+i*4.1, y:6.1, w:3.8, h:0.5, fontSize:11, color:C.dark, bold:true, fontFace:"Calibri", align:"center", valign:"middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2: AGENDA / OUTLINE
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionBg(slide);
  slide.addText("PRESENTATION OUTLINE", {
    x:0.5, y:0.2, w:12.3, h:0.7,
    fontSize:26, bold:true, color:C.white, fontFace:"Calibri", align:"center"
  });
  slide.addShape(pres.ShapeType.rect, { x:2.5, y:0.9, w:8.3, h:0.06, fill:{color:C.teal} });

  const sections = [
    { num:"01", title:"Pulmonary Hypertension — Definition, Classification & Pathophysiology", col:C.teal },
    { num:"02", title:"PH — Clinical Features, Diagnosis & Investigations", col:C.teal },
    { num:"03", title:"PH — Management: PAH Targeted Therapy (ESC/ERS 2022)", col:C.teal },
    { num:"04", title:"Venous Thromboembolism (VTE) — DVT Pathophysiology & Diagnosis", col:C.gold },
    { num:"05", title:"Acute Pulmonary Embolism — Classification (2026 AHA/ACC)", col:C.accent },
    { num:"06", title:"PE — Diagnosis Algorithm & Risk Stratification", col:C.accent },
    { num:"07", title:"PE — Management & Advanced Interventions (2026 Guideline)", col:C.accent },
    { num:"08", title:"CTEPH — Chronic Thromboembolic PH (PH Group 4)", col:C.gold },
    { num:"09", title:"Long-Term Management, Follow-Up & Key Takeaways", col:C.green },
  ];

  sections.forEach((s, i) => {
    const row = Math.floor(i/3);
    const col = i % 3;
    const x = 0.4 + col * 4.2;
    const y = 1.1 + row * 2.0;
    slide.addShape(pres.ShapeType.rect, { x, y, w:4.0, h:1.7, fill:{color:C.bgAlt}, shadow:{type:"outer",color:"000000",opacity:0.3,blur:4,offset:2,angle:45} });
    slide.addShape(pres.ShapeType.rect, { x, y, w:0.5, h:1.7, fill:{color:s.col} });
    slide.addText(s.num, { x:x+0.07, y:y+0.05, w:0.36, h:0.5, fontSize:18, bold:true, color:C.dark, fontFace:"Calibri", align:"center" });
    slide.addText(s.title, { x:x+0.6, y:y+0.1, w:3.3, h:1.5, fontSize:9.5, color:C.white, fontFace:"Calibri", valign:"middle", wrap:true });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 1 DIVIDER
// ══════════════════════════════════════════════════════════════════════════════
sectionDivider(pres, "01", "PULMONARY HYPERTENSION", "Definition · Classification · Pathophysiology", C.teal);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3: PH DEFINITION & UPDATED CRITERIA
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "PH Definition &\nUpdated Criteria", "ESC/ERS 2022 | World Symposium 2018");

  slide.addText("UPDATED HAEMODYNAMIC DEFINITION", {
    x:4.4, y:0.25, w:8.6, h:0.45,
    fontSize:15, bold:true, color:C.gold, fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.7, w:8.5, h:0.04, fill:{color:C.gold} });

  // mPAP box
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.85, w:8.5, h:1.5, fill:{color:C.bgAlt} });
  slide.addText("mPAP > 20 mmHg", {
    x:4.5, y:0.9, w:8.3, h:0.55,
    fontSize:22, bold:true, color:C.accent, fontFace:"Calibri"
  });
  slide.addText("(Previously >25 mmHg — threshold LOWERED by 6th World Symposium 2018, confirmed ESC/ERS 2022)", {
    x:4.5, y:1.4, w:8.3, h:0.7,
    fontSize:10, color:C.muted, fontFace:"Calibri", italic:true, wrap:true
  });

  // Subcategories
  const cats = [
    { label:"Pre-capillary PH", criteria:"mPAP >20 + PAWP ≤15 + PVR ≥3 WU", col:C.teal, groups:"Groups 1, 3, 4, 5" },
    { label:"Post-capillary PH (IpcPH)", criteria:"mPAP >20 + PAWP >15 + PVR <3 WU", col:C.orange, groups:"Group 2" },
    { label:"Combined Pre+Post-capillary (CpcPH)", criteria:"mPAP >20 + PAWP >15 + PVR ≥3 WU", col:C.accent, groups:"Groups 2, 5" },
  ];
  cats.forEach((c, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.87, y:2.5, w:2.7, h:2.6, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.87, y:2.5, w:2.7, h:0.45, fill:{color:c.col} });
    slide.addText(c.label, { x:4.4+i*2.87, y:2.52, w:2.7, h:0.4, fontSize:9.5, bold:true, color:C.white, fontFace:"Calibri", align:"center" });
    slide.addText(c.criteria, { x:4.5+i*2.87, y:3.1, w:2.5, h:1.0, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
    slide.addText(c.groups, { x:4.5+i*2.87, y:4.7, w:2.5, h:0.3, fontSize:9, color:c.col, bold:true, fontFace:"Calibri" });
  });

  slide.addText("RHC = gold standard for diagnosis  |  PVR: Pulmonary Vascular Resistance (Wood Units)  |  PAWP: Pulmonary Artery Wedge Pressure", {
    x:4.4, y:5.3, w:8.7, h:0.5,
    fontSize:8.5, color:C.muted, fontFace:"Calibri", italic:true
  });

  addBullets(slide, [
    "Exercise PH: mPAP/CO slope >3 WU during exercise",
    "Borderline PH: mPAP 21–24 mmHg — watch and investigate",
    "Symptoms: dyspnea on exertion, fatigue, syncope, chest pain",
    "Physical signs: loud P2, RV heave, TR murmur, JVD"
  ], 0.2, 3.5, 4.0, 3.5, 11, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4: WHO CLASSIFICATION (5 GROUPS)
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "WHO Clinical\nClassification\nof PH", "5 Groups — ESC/ERS 2022");

  slide.addText("5 WHO GROUPS OF PULMONARY HYPERTENSION", {
    x:4.4, y:0.2, w:8.6, h:0.5,
    fontSize:15, bold:true, color:C.white, fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.7, w:8.5, h:0.04, fill:{color:C.accent} });

  const groups = [
    { num:"1", name:"PAH — Pulmonary Arterial Hypertension", col:C.teal, detail:"Idiopathic, heritable (BMPR2), drug/toxin-induced, CTD-PAH, HIV, portal HTN, CHD", key:"Pre-capillary | PVR ≥3 WU | PAWP ≤15" },
    { num:"2", name:"PH due to Left Heart Disease", col:C.gold, detail:"HFpEF, HFrEF, valvular disease (mitral/aortic), congenital LV inflow obstruction", key:"Post-capillary | Most common form of PH" },
    { num:"3", name:"PH due to Lung Disease / Hypoxia", col:C.orange, detail:"COPD, ILD, OSA, hypoventilation, high-altitude. Often mild-moderate PH", key:"Pre-capillary | Treat underlying lung disease" },
    { num:"4", name:"CTEPH — Chronic Thromboembolic PH", col:C.accent, detail:"Organised thrombi after PE → surgical cure possible (PTE). BPA for inoperable", key:"Pre-capillary | ONLY surgically curable form" },
    { num:"5", name:"PH with Unclear / Multifactorial Mechanisms", col:C.muted, detail:"Haematologic: CML, splenectomy. Systemic: sarcoid, Langerhans, NF-1. Metabolic", key:"Mixed / unclear mechanisms" },
  ];

  groups.forEach((g, i) => {
    const y = 0.85 + i * 1.22;
    slide.addShape(pres.ShapeType.rect, { x:4.4, y, w:0.55, h:1.1, fill:{color:g.col} });
    slide.addText(g.num, { x:4.4, y, w:0.55, h:1.1, fontSize:22, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle" });
    slide.addShape(pres.ShapeType.rect, { x:4.95, y, w:8.0, h:1.1, fill:{color:C.bgAlt} });
    slide.addText(g.name, { x:5.05, y:y+0.05, w:7.8, h:0.38, fontSize:12, bold:true, color:C.white, fontFace:"Calibri" });
    slide.addText(g.detail, { x:5.05, y:y+0.42, w:5.8, h:0.45, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
    slide.addText(g.key, { x:11.0, y:y+0.42, w:2.0, h:0.5, fontSize:8, color:g.col, fontFace:"Calibri", italic:true, wrap:true });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5: PH PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "Pathophysiology\nof PAH", "Vascular Remodelling & RV Failure");

  slide.addText("THREE KEY PATHWAYS IN PULMONARY VASCULAR REMODELLING", {
    x:4.4, y:0.2, w:8.6, h:0.45,
    fontSize:13, bold:true, color:C.gold, fontFace:"Calibri"
  });

  const pathways = [
    { name:"NO-cGMP Pathway ↓", detail:"Reduced eNOS → ↓ NO → ↓ cGMP → vasoconstriction\nTherapy: PDE5i (sildenafil, tadalafil), sGC stimulators (riociguat)", col:C.teal },
    { name:"Prostacyclin Pathway ↓", detail:"↓ prostacyclin synthase → ↓ IP receptor → vasoconstriction\nTherapy: PGI2 analogues (epoprostenol, treprostinil), IP agonists (selexipag)", col:C.gold },
    { name:"Endothelin-1 Pathway ↑", detail:"↑ ET-1 → ETA & ETB receptor → vasoconstriction + proliferation\nTherapy: ERAs (ambrisentan, bosentan, macitentan)", col:C.accent },
  ];
  pathways.forEach((p, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.95, y:0.75, w:2.8, h:2.8, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.95, y:0.75, w:2.8, h:0.5, fill:{color:p.col} });
    slide.addText(p.name, { x:4.4+i*2.95, y:0.76, w:2.8, h:0.48, fontSize:11, bold:true, color:C.white, fontFace:"Calibri", align:"center" });
    slide.addText(p.detail, { x:4.5+i*2.95, y:1.35, w:2.6, h:2.0, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
  });

  slide.addText("RV REMODELLING CASCADE", {
    x:4.4, y:3.75, w:8.6, h:0.4,
    fontSize:12, bold:true, color:C.teal, fontFace:"Calibri"
  });

  const cascade = ["↑ Pulmonary Vascular Resistance", "→ RV Pressure Overload", "→ RV Hypertrophy (adaptive)", "→ RV Dilatation + Dysfunction", "→ Ventricular Interdependence (D-septum)", "→ LV Compression + ↓ CO", "→ Death"];
  const cascadeX = [4.4, 5.7, 7.0, 8.3, 9.6, 10.9, 12.2];
  cascade.forEach((c, i) => {
    slide.addShape(pres.ShapeType.rect, { x:cascadeX[i], y:4.2, w:1.15, h:0.8, fill:{color: i===6?C.accent:C.bgAlt} });
    slide.addText(c, { x:cascadeX[i]+0.05, y:4.2, w:1.05, h:0.8, fontSize:7.5, color:i===6?C.white:C.light, fontFace:"Calibri", align:"center", valign:"middle", wrap:true });
  });

  addBullets(slide, [
    "BMPR2 mutation: 70% hereditary PAH",
    "Loss of anti-proliferative BMP signalling",
    "Pro-apoptotic signals → endothelial injury",
    "Medial hypertrophy + intimal fibrosis",
    "In-situ thrombosis common in PAH",
    "Plexiform lesions: pathognomonic",
    "Inflammation key in CTD-PAH, HIV-PAH"
  ], 0.2, 0.8, 3.9, 4.5, 10.5, C.light);

  slide.addText("New mechanism: Sotatercept (activin receptor ligand trap) targets TGF-β/BMP imbalance — FDA approved 2024 for PAH", {
    x:4.4, y:5.2, w:8.7, h:0.6,
    fontSize:9.5, color:C.gold, fontFace:"Calibri", italic:true, wrap:true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6: PH — CLINICAL FEATURES & INVESTIGATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "PH — Clinical\nFeatures &\nInvestigations", "Diagnosis Algorithm");

  slide.addText("SYMPTOMS & SIGNS", {
    x:4.4, y:0.2, w:4.0, h:0.4,
    fontSize:13, bold:true, color:C.gold, fontFace:"Calibri"
  });
  addBullets(slide, [
    { text:"Dyspnoea on exertion (earliest)", bold:true },
    "Fatigue, lethargy",
    "Syncope/pre-syncope (exertional)",
    "Chest pain (RV ischaemia)",
    { text:"Signs: Loud P2, RV heave, JVD", bold:false },
    "TR murmur, peripheral oedema",
    "Hepatomegaly, ascites (late)",
    "Raynaud's (CTD-PAH)"
  ], 4.4, 0.65, 3.8, 3.5, 10.5, C.light);

  slide.addText("WHO FUNCTIONAL CLASS (FC)", {
    x:8.5, y:0.2, w:4.5, h:0.4,
    fontSize:13, bold:true, color:C.teal, fontFace:"Calibri"
  });
  const fcRows = [
    { fc:"I", desc:"No symptoms with ordinary activity", col:C.green },
    { fc:"II", desc:"Slight limitation — comfortable at rest; symptoms with ordinary activity", col:C.yellow },
    { fc:"III", desc:"Marked limitation — comfortable at rest; symptoms with less than ordinary activity", col:C.orange },
    { fc:"IV", desc:"Symptoms at rest; unable to carry on any physical activity", col:C.red },
  ];
  fcRows.forEach((r, i) => {
    slide.addShape(pres.ShapeType.rect, { x:8.5, y:0.65+i*0.95, w:0.55, h:0.85, fill:{color:r.col} });
    slide.addText(`FC ${r.fc}`, { x:8.5, y:0.65+i*0.95, w:0.55, h:0.85, fontSize:10, bold:true, color:C.dark, fontFace:"Calibri", align:"center", valign:"middle" });
    slide.addShape(pres.ShapeType.rect, { x:9.05, y:0.65+i*0.95, w:4.0, h:0.85, fill:{color:C.bgAlt} });
    slide.addText(r.desc, { x:9.1, y:0.68+i*0.95, w:3.9, h:0.8, fontSize:9, color:C.light, fontFace:"Calibri", valign:"middle", wrap:true });
  });

  slide.addShape(pres.ShapeType.rect, { x:4.4, y:4.3, w:8.6, h:0.04, fill:{color:C.accent} });
  slide.addText("INVESTIGATIONS", {
    x:4.4, y:4.4, w:8.6, h:0.4,
    fontSize:13, bold:true, color:C.accent, fontFace:"Calibri"
  });

  const investCols = [
    { title:"Screening", items:["ECG: RVH, RAD, P-pulmonale, RBBB","Echo: sPAP >36 mmHg = PH likely","6MWD (6-min walk distance)","BNP/NT-proBNP (prognosis)","CXR: PA enlargement, pruning"] },
    { title:"Confirm PH", items:["V/Q scan (CTEPH screen)","CTPA: PE, parenchymal disease","HRCT chest: ILD","PFTs + DLCO","HIV, LFT, TFT, ANA, anti-SCL70"] },
    { title:"Definitive (RHC)", items:["mPAP, PAWP, PVR, CO","Vasoreactivity test (iNO/adenosine)","Response: ↓mPAP ≥10 to <40 mmHg","Indicates CCB responders (~10%)","Required before starting PAH therapy"] },
  ];
  investCols.forEach((col, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:4.9, w:2.75, h:2.45, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:4.9, w:2.75, h:0.45, fill:{color:C.bgAlt} });
    slide.addText(col.title, { x:4.4+i*2.9, y:4.9, w:2.75, h:0.45, fontSize:11, bold:true, color:C.teal, fontFace:"Calibri", align:"center" });
    const textArr = col.items.map((item, idx) => ({
      text: item,
      options: { color:C.light, fontSize:9, bullet:true, fontFace:"Calibri", breakLine: idx < col.items.length-1 }
    }));
    slide.addText(textArr, { x:4.5+i*2.9, y:5.4, w:2.55, h:1.9, valign:"top" });
  });

  addBullets(slide, [
    { text:"Echo criteria for PH:", bold:true },
    "TRV >3.4 m/s = high prob",
    "TRV 2.9–3.4 = intermediate",
    "TRV <2.9 + other signs = intermediate",
    { text:"Other echo signs:", bold:true },
    "RV:LV ratio >1.0",
    "TAPSE <17 mm (RV dysfunction)",
    "IVC dilation > 2.1 cm"
  ], 0.2, 4.35, 3.9, 3.0, 10, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7: PAH MANAGEMENT — ESC/ERS 2022
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "PAH Management\n(Group 1)\nESC/ERS 2022", "Risk-Stratified Approach");

  slide.addText("RISK STRATIFICATION AT DIAGNOSIS (3-STRATA MODEL)", {
    x:4.4, y:0.2, w:8.7, h:0.4,
    fontSize:12, bold:true, color:C.gold, fontFace:"Calibri"
  });

  const risk = [
    { level:"LOW RISK", desc:"FC I-II | 6MWD >440m | BNP <50 | No RVF | TAPSE >20 | CI >2.5", col:C.green },
    { level:"INTERMEDIATE RISK", desc:"FC III | 6MWD 165–440m | BNP 50–300 | RA area >18 cm² | TAPSE 12–20", col:C.yellow },
    { level:"HIGH RISK", desc:"FC IV | 6MWD <165m | BNP >300 | Pericardial effusion | TAPSE <12 | CI <2.0", col:C.red },
  ];
  risk.forEach((r, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:0.7, w:2.75, h:1.9, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:0.7, w:2.75, h:0.45, fill:{color:r.col} });
    slide.addText(r.level, { x:4.4+i*2.9, y:0.7, w:2.75, h:0.45, fontSize:10, bold:true, color:C.dark, fontFace:"Calibri", align:"center" });
    slide.addText(r.desc, { x:4.5+i*2.9, y:1.2, w:2.55, h:1.3, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
  });

  slide.addShape(pres.ShapeType.rect, { x:4.4, y:2.75, w:8.6, h:0.04, fill:{color:C.teal} });
  slide.addText("INITIAL COMBINATION THERAPY (ESC/ERS 2022 — GRADE I, Level A)", {
    x:4.4, y:2.85, w:8.7, h:0.45,
    fontSize:12, bold:true, color:C.teal, fontFace:"Calibri"
  });

  const therapyRows = [
    { title:"Low/Intermediate Risk (de novo)", detail:"ERA + PDE5i (e.g. AMBITION trial: ambrisentan + tadalafil — Class I A)", col:C.teal },
    { title:"High Risk", detail:"ERA + PDE5i + SC/IV prostanoid (triple therapy); consider epoprostenol (Class I A)", col:C.accent },
    { title:"Vasoreactive (CCB response +ve)", detail:"Calcium channel blockers first (nifedipine, diltiazem, amlodipine) — only ~10% eligible", col:C.gold },
    { title:"SOTATERCEPT (2024)", detail:"Activin receptor ligand trap — add-on for PAH; FDA/EMA approved; STELLAR trial showed ↑ 6MWD, improved FC", col:C.green },
  ];
  therapyRows.forEach((t, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4, y:3.4+i*0.9, w:0.2, h:0.8, fill:{color:t.col} });
    slide.addShape(pres.ShapeType.rect, { x:4.6, y:3.4+i*0.9, w:8.3, h:0.8, fill:{color:C.bgAlt} });
    slide.addText(t.title, { x:4.7, y:3.42+i*0.9, w:3.5, h:0.36, fontSize:10, bold:true, color:t.col, fontFace:"Calibri" });
    slide.addText(t.detail, { x:4.7, y:3.77+i*0.9, w:8.1, h:0.38, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
  });

  addBullets(slide, [
    { text:"General measures:", bold:true },
    "Avoid pregnancy (teratogenic drugs)",
    "Supervised exercise/rehab",
    "Diuretics for fluid overload",
    "Oral anticoagulation: consider in IPAH",
    "O2 if SpO2 <91% at rest",
    { text:"Escalation / Rescue:", bold:true },
    "IV epoprostenol (most potent)",
    "Lung transplantation (bilateral)",
    "Balloon atrial septostomy (palliation)"
  ], 0.2, 0.8, 3.9, 6.5, 10, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 2 DIVIDER
// ══════════════════════════════════════════════════════════════════════════════
sectionDivider(pres, "02", "VENOUS THROMBOEMBOLISM", "DVT · Pathophysiology · Diagnosis", C.gold);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8: VTE — PATHOPHYSIOLOGY & RISK FACTORS
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "VTE\nPathophysiology\n& Risk Factors", "Virchow's Triad");

  slide.addText("VIRCHOW'S TRIAD — THE THREE PILLARS OF THROMBOSIS", {
    x:4.4, y:0.2, w:8.7, h:0.4,
    fontSize:12, bold:true, color:C.gold, fontFace:"Calibri"
  });

  const triad = [
    { name:"Venous Stasis", examples:"Immobility, long-haul travel, paralysis, CCF, obesity, varicose veins, pregnancy", col:C.teal, icon:"≈" },
    { name:"Endothelial Injury", examples:"Surgery, trauma, IV catheters, vasculitis, hyperhomocysteinaemia, anticardiolipin Ab", col:C.accent, icon:"✕" },
    { name:"Hypercoagulability", examples:"Factor V Leiden, Protein C/S deficiency, antithrombin deficiency, OCP, malignancy, APS, pregnancy", col:C.gold, icon:"↑" },
  ];
  triad.forEach((t, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.95, y:0.7, w:2.8, h:3.0, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.95, y:0.7, w:2.8, h:0.55, fill:{color:t.col} });
    slide.addText(`${t.icon}  ${t.name}`, { x:4.4+i*2.95, y:0.7, w:2.8, h:0.55, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", align:"center" });
    slide.addText(t.examples, { x:4.5+i*2.95, y:1.35, w:2.6, h:2.2, fontSize:9.5, color:C.light, fontFace:"Calibri", wrap:true });
  });

  slide.addShape(pres.ShapeType.rect, { x:4.4, y:3.85, w:8.6, h:0.04, fill:{color:C.accent} });
  slide.addText("DVT — CLINICAL FEATURES & DIAGNOSIS", {
    x:4.4, y:3.95, w:8.6, h:0.4,
    fontSize:12, bold:true, color:C.accent, fontFace:"Calibri"
  });

  const dvtCols = [
    { title:"Clinical Signs", items:["Calf pain, tenderness","Swelling, erythema","Warmth","Pitting oedema","Homans sign (unreliable)","Phlegmasia cerulea dolens (massive DVT)"] },
    { title:"Pre-test: Wells DVT Score", items:["Active cancer (+1)","Paralysis/immobility (+1)","Bedridden >3d / major surgery (+1)","Localised DVT tenderness (+1)","Entire leg swollen (+1)","Calf swelling ≥3cm (+1)","Collateral veins (+1)","Pitting oedema (+1)","Alt Dx as likely as DVT (−2)","≥2: High prob | 1: Moderate | <1: Low"] },
    { title:"Investigations", items:["D-dimer (sensitive, not specific)","Compression duplex USS (1st line)","CT venography (pelvic/abdominal)","MRI venography (pregnancy)","Negative D-dimer + low Wells = excludes DVT"] },
  ];
  dvtCols.forEach((col, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:4.45, w:2.75, h:3.0, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:4.45, w:2.75, h:0.4, fill:{color:C.bgAlt} });
    slide.addText(col.title, { x:4.4+i*2.9, y:4.45, w:2.75, h:0.4, fontSize:10, bold:true, color:C.teal, fontFace:"Calibri", align:"center" });
    const textArr = col.items.map((item, idx) => ({
      text: item, options:{ color:C.light, fontSize:8.5, bullet:true, fontFace:"Calibri", breakLine:idx<col.items.length-1 }
    }));
    slide.addText(textArr, { x:4.5+i*2.9, y:4.9, w:2.55, h:2.5, valign:"top" });
  });

  addBullets(slide, [
    { text:"Epidemiology:", bold:true },
    "VTE: 3rd leading cardiovascular cause of death",
    "Incidence: 1–2 per 1000 person-years",
    "DVT: 60–70% of all VTE",
    "30-day mortality PE: ~10–15%",
    { text:"Hereditary thrombophilia:", bold:true },
    "Factor V Leiden: Most common (5% pop.)",
    "Prothrombin G20210A mutation",
    "Protein C/S, Antithrombin deficiency",
    { text:"Acquired:", bold:true },
    "APS, malignancy, pregnancy",
    "HIT (heparin-induced)"
  ], 0.2, 0.8, 3.9, 6.5, 9.5, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 3 DIVIDER
// ══════════════════════════════════════════════════════════════════════════════
sectionDivider(pres, "03", "ACUTE PULMONARY EMBOLISM", "2026 AHA/ACC Clinical Category Classification", C.accent);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9: PE CLASSIFICATION — 2026 AHA/ACC CATEGORIES A–E
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "2026 AHA/ACC\nPE Clinical\nCategories A–E", "NEW — De Novo Classification");

  slide.addText("AHA/ACC ACUTE PE CLINICAL CATEGORIES — 2026 GUIDELINE (1st EVER JOINT GUIDELINE)", {
    x:4.4, y:0.18, w:8.7, h:0.45,
    fontSize:11, bold:true, color:C.gold, fontFace:"Calibri"
  });

  const peCats = [
    { cat:"A", label:"Subclinical / Incidental", hemo:"Asymptomatic", rv:"Normal RV & biomarkers", mgmt:"Anticoagulation (DOAC). Discharge home. No hospitalisation needed.", col:C.green },
    { cat:"B", label:"Low Severity", hemo:"Symptomatic | SBP ≥90", rv:"Normal RV / no significant biomarker rise (C1)", mgmt:"Anticoagulation; early discharge. Outpatient management generally safe.", col:C.yellow },
    { cat:"C", label:"Intermediate Severity", hemo:"Symptomatic | SBP ≥90 | C1: normal RV + no biomarkers | C2: abnormal RV OR biomarkers | C3: abnormal RV AND biomarkers", rv:"C3 = highest within Category C", mgmt:"Anticoagulate; hospitalise. C3: consider CDL or PERT engagement if deteriorating.", col:C.orange },
    { cat:"D", label:"High Severity (Non-obstructive Shock)", hemo:"SBP <90 OR ↓40 mmHg ≥15min (not explained by arrhythmia/sepsis)", rv:"Severe RV dysfunction + biomarker elevation", mgmt:"PERT activation, UFH, consider CDL/MT/surgical embolectomy. Haemodynamic support.", col:C.red },
    { cat:"E", label:"Obstructive Cardiogenic Shock / Arrest", hemo:"E1: Cardiogenic shock with persistent hypotension | E2: Cardiac arrest", rv:"Severe RV failure, refractory shock", mgmt:"ECMO, systemic thrombolysis (E2: cardiac arrest), surgical/catheter embolectomy. ICU.", col:C.accent },
  ];

  peCats.forEach((c, i) => {
    const y = 0.72 + i * 1.21;
    slide.addShape(pres.ShapeType.rect, { x:4.4, y, w:0.7, h:1.1, fill:{color:c.col} });
    slide.addText(`CAT\n${c.cat}`, { x:4.4, y, w:0.7, h:1.1, fontSize:11, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle" });
    slide.addShape(pres.ShapeType.rect, { x:5.1, y, w:8.0, h:1.1, fill:{color:C.bgAlt} });
    slide.addText(c.label, { x:5.2, y:y+0.04, w:7.8, h:0.32, fontSize:10.5, bold:true, color:c.col, fontFace:"Calibri" });
    slide.addText(`Haemodynamics: ${c.hemo}  |  RV: ${c.rv}`, { x:5.2, y:y+0.35, w:7.8, h:0.32, fontSize:8.5, color:C.muted, fontFace:"Calibri", italic:true });
    slide.addText(`Mgmt: ${c.mgmt}`, { x:5.2, y:y+0.65, w:7.8, h:0.38, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
  });

  addBullets(slide, [
    { text:"KEY CHANGE:", bold:true, color:C.gold },
    { text:"Old: massive/submassive/low-risk", bold:false },
    { text:"New: Categories A–E (5 categories)", bold:false },
    "Subcategories (C1,C2,C3,D1,D2,E1,E2)",
    "Based on: symptoms, haemodynamics, RV size/function, biomarkers",
    { text:"Enables precise therapy decision", bold:true },
    "Cat A+B → safe for early/home discharge",
    "Cat C3-D → PERT activation recommended",
    "Cat E → aggressive intervention"
  ], 0.15, 0.72, 4.05, 5.8, 9.5, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10: PE DIAGNOSIS ALGORITHM
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "PE Diagnosis\nAlgorithm &\nRisk Scores", "Wells · PESI · D-dimer");

  slide.addText("DIAGNOSTIC ALGORITHM FOR SUSPECTED PE (2026 GUIDELINE)", {
    x:4.4, y:0.2, w:8.7, h:0.4,
    fontSize:12, bold:true, color:C.white, fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.62, w:8.6, h:0.04, fill:{color:C.teal} });

  // Algorithm flow
  const algoSteps = [
    { step:"Clinical Suspicion\n(Dyspnoea, pleuritic pain, tachycardia, hypoxia, risk factors)", col:C.teal, x:4.4, y:0.75, w:5.2 },
    { step:"Assess haemodynamic stability\nUnstable → EMERGENT CTPA / Bedside Echo / Empiric anticoagulation", col:C.accent, x:4.4, y:1.7, w:5.2 },
    { step:"Wells PE Score\n≤4: Low/Moderate → D-dimer first\n>4: High probability → CTPA directly", col:C.gold, x:4.4, y:2.75, w:5.2 },
    { step:"D-dimer (age-adjusted: D-dimer < age×10 if ≥50yrs)\nNegative → PE excluded\nPositive → CTPA", col:C.teal, x:4.4, y:3.8, w:5.2 },
    { step:"CTPA — Gold Standard (Sensitivity 95%, Specificity 98%)\nAlternative: V/Q scan (pregnancy, CKD, dye allergy)", col:C.green, x:4.4, y:4.85, w:5.2 },
  ];
  algoSteps.forEach((s, i) => {
    slide.addShape(pres.ShapeType.rect, { x:s.x, y:s.y, w:s.w, h:0.85, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:s.x, y:s.y, w:0.18, h:0.85, fill:{color:s.col} });
    slide.addText(s.step, { x:s.x+0.25, y:s.y+0.05, w:s.w-0.3, h:0.78, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
    if (i < algoSteps.length-1) {
      slide.addText("▼", { x:s.x+2.3, y:s.y+0.82, w:0.6, h:0.28, fontSize:12, color:s.col, fontFace:"Calibri", align:"center" });
    }
  });

  // Wells Score
  slide.addText("WELLS PE SCORE", {
    x:9.8, y:0.65, w:3.5, h:0.38,
    fontSize:11, bold:true, color:C.gold, fontFace:"Calibri"
  });
  const wellsPE = [
    "Clinical signs DVT: +3",
    "PE most likely Dx: +3",
    "HR >100: +1.5",
    "Immobilisation ≥3d / surgery: +1.5",
    "Prev DVT/PE: +1.5",
    "Haemoptysis: +1",
    "Malignancy (Rx active): +1",
    "Score >4 = PE likely",
    "Score ≤4 = PE unlikely",
  ];
  addBullets(slide, wellsPE, 9.8, 1.1, 3.35, 3.0, 9, C.light);

  // PESI Score
  slide.addText("sPESI (Simplified PESI)", {
    x:9.8, y:4.3, w:3.5, h:0.38,
    fontSize:11, bold:true, color:C.teal, fontFace:"Calibri"
  });
  const spesi = [
    "Age >80: +1",
    "Cancer: +1",
    "Chronic cardiopulmonary: +1",
    "HR ≥110: +1",
    "SBP <100: +1",
    "SpO2 <90%: +1",
    "Score 0 = low risk (30d mortality 1%)",
    "Score ≥1 = high risk (10.9%)",
  ];
  addBullets(slide, spesi, 9.8, 4.75, 3.35, 2.5, 9, C.light);

  addBullets(slide, [
    { text:"Biomarkers in PE:", bold:true },
    "Troponin I/T: RV micronecrosis → mortality risk",
    "BNP/NT-proBNP: RV wall stress",
    "Lactate: tissue perfusion",
    "Echo: RV:LV >0.9, McConnell sign, D-sign",
    { text:"ECG:", bold:true },
    "S1Q3T3 (25% sensitive)",
    "Sinus tachycardia (most common)",
    "New RBBB, T-wave inversions V1-V4",
    "AF possible in massive PE"
  ], 0.2, 0.8, 3.9, 5.5, 9.5, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11: PE MANAGEMENT — 2026 GUIDELINE
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "PE Management\n2026 AHA/ACC\nGuideline", "Anticoagulation to Advanced Interventions");

  slide.addText("ANTICOAGULATION — FIRST-LINE TREATMENT (ALL CATEGORIES)", {
    x:4.4, y:0.2, w:8.7, h:0.42,
    fontSize:12, bold:true, color:C.gold, fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.65, w:8.6, h:0.04, fill:{color:C.gold} });

  const acRows = [
    { drug:"DOACs (Preferred)", detail:"Rivaroxaban: 15mg BD ×21d → 20mg OD | Apixaban: 10mg BD ×7d → 5mg BD | Edoxaban: after 5–10d UFH/LMWH | Dabigatran: after 5-10d parenteral", col:C.teal },
    { drug:"LMWH", detail:"Enoxaparin 1mg/kg SC BD or 1.5mg/kg OD. Preferred in cancer (superior to VKA), pregnancy (DOACs contraindicated)", col:C.gold },
    { drug:"UFH", detail:"Bolus 80 IU/kg → infusion 18 IU/kg/hr. Preferred if renal failure, need for reversal, or advanced intervention planned", col:C.orange },
    { drug:"Warfarin (VKA)", detail:"INR 2–3. Only if DOAC contraindicated (APS, valvular disease, pregnancy planned, renal failure). Overlap UFH/LMWH ≥5d until INR therapeutic ×24h", col:C.muted },
  ];
  acRows.forEach((r, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.8+i*0.95, w:1.8, h:0.85, fill:{color:r.col} });
    slide.addText(r.drug, { x:4.4, y:0.8+i*0.95, w:1.8, h:0.85, fontSize:9, bold:true, color:C.dark, fontFace:"Calibri", align:"center", valign:"middle" });
    slide.addShape(pres.ShapeType.rect, { x:6.2, y:0.8+i*0.95, w:6.8, h:0.85, fill:{color:C.bgAlt} });
    slide.addText(r.detail, { x:6.3, y:0.83+i*0.95, w:6.6, h:0.8, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
  });

  slide.addShape(pres.ShapeType.rect, { x:4.4, y:4.7, w:8.6, h:0.04, fill:{color:C.accent} });
  slide.addText("ADVANCED INTERVENTIONS — CATEGORY C3/D/E", {
    x:4.4, y:4.8, w:8.7, h:0.42,
    fontSize:12, bold:true, color:C.accent, fontFace:"Calibri"
  });

  const advTherapy = [
    { title:"Systemic Thrombolysis", detail:"Alteplase 100mg IV over 2h. Cat E (cardiac arrest/obstructive shock). Contraindicated if recent surgery, stroke, active bleeding. Major bleeding 9.9%, ICH 1.7%", col:C.accent },
    { title:"Catheter-Directed Lysis (CDL)", detail:"Local low-dose tPA via catheter. Cat C3-D2 if deteriorating/high risk. Lower bleeding vs systemic. Not yet vs anticoagulation head-to-head in RCT", col:C.orange },
    { title:"Mechanical Thrombectomy (MT)", detail:"Catheter-based: FlowTriever, Inari, AngioVac. Cat D-E. No lytic agent → lower bleeding risk. Growing evidence base.", col:C.gold },
    { title:"Surgical Embolectomy", detail:"Cat D1-E2. Open-heart surgery — high survival >97% in experienced centres when cat E1. Viable if thrombolysis contraindicated/failed.", col:C.teal },
  ];
  advTherapy.forEach((t, i) => {
    const col = i < 2 ? 0 : 1;
    const row = i % 2;
    slide.addShape(pres.ShapeType.rect, { x:4.4+col*4.35, y:5.35+row*0.9, w:4.2, h:0.82, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+col*4.35, y:5.35+row*0.9, w:0.18, h:0.82, fill:{color:t.col} });
    slide.addText(t.title, { x:4.65+col*4.35, y:5.38+row*0.9, w:3.8, h:0.3, fontSize:9.5, bold:true, color:t.col, fontFace:"Calibri" });
    slide.addText(t.detail, { x:4.65+col*4.35, y:5.67+row*0.9, w:3.8, h:0.45, fontSize:8, color:C.light, fontFace:"Calibri", wrap:true });
  });

  addBullets(slide, [
    { text:"IVC Filters (2026):", bold:true },
    "Retrievable filter if anticoagulation CONTRAINDICATED",
    "NOT recommended routinely alongside anticoagulation",
    "Retrieve as soon as possible once anticoagulant safe",
    { text:"PERT — PE Response Team:", bold:true },
    "Multidisciplinary: pulm, cards, CT surg, IR, heme",
    "Activate for Cat C3 and above",
    "Shown to improve time to intervention",
    { text:"Haemodynamic support:", bold:true },
    "Vasopressors: noradrenaline preferred",
    "Avoid excessive IV fluids (RV distension worsens)",
    "ECMO: bridge in Cat E (COR 2a)"
  ], 0.2, 0.8, 3.9, 6.5, 9.5, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12: CTEPH
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "CTEPH\n(WHO Group 4)\nChronic Thrombo-\nembolic PH", "Only Surgically Curable Form of PH");

  slide.addText("CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION", {
    x:4.4, y:0.18, w:8.7, h:0.45,
    fontSize:13, bold:true, color:C.gold, fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.65, w:8.6, h:0.04, fill:{color:C.gold} });

  // Key facts
  const facts = [
    { label:"Incidence after PE", value:"~4% after acute PE; 25% have no prior PE history" },
    { label:"Pathogenesis", value:"Failed clot resolution → organised intravascular scar → ↑PVR → PH. Delayed diagnosis (>2 weeks) is key risk factor" },
    { label:"Risk Factors", value:"Recurrent PE, large PE, mPAP >50 at diagnosis, residual perfusion defect, APS, splenectomy, infected pacemaker leads" },
    { label:"Presentation", value:"Progressive dyspnoea months-years after PE. Clinically indistinguishable from PAH. Requires high suspicion" },
  ];
  facts.forEach((f, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.8+i*0.78, w:2.0, h:0.68, fill:{color:C.teal} });
    slide.addText(f.label, { x:4.4, y:0.8+i*0.78, w:2.0, h:0.68, fontSize:9, bold:true, color:C.dark, fontFace:"Calibri", align:"center", valign:"middle" });
    slide.addShape(pres.ShapeType.rect, { x:6.4, y:0.8+i*0.78, w:6.6, h:0.68, fill:{color:C.bgAlt} });
    slide.addText(f.value, { x:6.5, y:0.82+i*0.78, w:6.4, h:0.65, fontSize:9, color:C.light, fontFace:"Calibri", wrap:true });
  });

  // Diagnosis
  slide.addText("DIAGNOSTIC PATHWAY FOR CTEPH", {
    x:4.4, y:4.0, w:8.7, h:0.4,
    fontSize:11, bold:true, color:C.teal, fontFace:"Calibri"
  });

  const diagSteps = [
    { s:"V/Q Scan\n(Screen for CTEPH — superior to CTPA for screening)", col:C.teal },
    { s:"CTPA\n(Characterise clot burden, vessel morphology, parenchymal disease)", col:C.gold },
    { s:"Right Heart Catheterisation\n(Confirm PH: mPAP >20, PVR ≥3 WU; PAWP ≤15)", col:C.accent },
    { s:"Digital Subtraction Angiography\n(Pre-operative mapping; webs, bands, pouching defects)", col:C.orange },
  ];
  diagSteps.forEach((d, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.2, y:4.5, w:2.05, h:1.2, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.2, y:4.5, w:2.05, h:0.2, fill:{color:d.col} });
    slide.addText((i+1).toString(), { x:4.4+i*2.2, y:4.7, w:0.5, h:0.5, fontSize:20, bold:true, color:d.col, fontFace:"Calibri", align:"center" });
    slide.addText(d.s, { x:4.9+i*2.2, y:4.55, w:1.5, h:1.1, fontSize:8.5, color:C.light, fontFace:"Calibri", wrap:true });
  });

  // Treatment
  slide.addText("TREATMENT", {
    x:4.4, y:5.85, w:8.7, h:0.38,
    fontSize:11, bold:true, color:C.accent, fontFace:"Calibri"
  });

  const treatments = [
    { title:"PTE (Pulmonary Thromboendarterectomy)", detail:"SURGICAL CURE — treatment of choice for operable proximal disease. Survival >90%. Life-long anticoagulation post-op.", col:C.green },
    { title:"Balloon Pulmonary Angioplasty (BPA)", detail:"For inoperable or residual CTEPH. Serial sessions. ↑ haemodynamics + exercise capacity. Riociguat as adjunct.", col:C.teal },
    { title:"Medical: Riociguat", detail:"sGC stimulator — ONLY drug approved specifically for CTEPH. CHEST-1 trial: ↑6MWD, ↓PVR. Use if inoperable or residual post-PTE.", col:C.gold },
  ];
  treatments.forEach((t, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:6.3, w:2.75, h:1.1, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:4.4+i*2.9, y:6.3, w:2.75, h:0.3, fill:{color:t.col} });
    slide.addText(t.title, { x:4.45+i*2.9, y:6.3, w:2.65, h:0.3, fontSize:8.5, bold:true, color:C.dark, fontFace:"Calibri" });
    slide.addText(t.detail, { x:4.45+i*2.9, y:6.65, w:2.65, h:0.7, fontSize:8, color:C.light, fontFace:"Calibri", wrap:true });
  });

  addBullets(slide, [
    { text:"CTEPH Key Points:", bold:true },
    "Screen ALL PE patients at 3–6 months",
    "Echo at follow-up: PH signs?",
    "V/Q scan: gold standard screen",
    "Expert referral mandatory",
    "Lifelong anticoagulation",
    { text:"Post-PTE outcomes:", bold:true },
    "60–80% normalise haemodynamics",
    "25% residual or recurrent PH",
    "Lung transplant: last resort",
    { text:"CTPA vs V/Q:", bold:true },
    "V/Q better for CTEPH screening",
    "CTPA: anatomic detail pre-op",
    "Both often performed"
  ], 0.2, 0.8, 3.9, 6.5, 9.5, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13: LONG-TERM MANAGEMENT & FOLLOW-UP
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slideHeader(slide, "Long-Term\nManagement\n& Follow-Up", "Post-PE Syndrome · Anticoagulation Duration");

  slide.addText("DURATION OF ANTICOAGULATION AFTER VTE/PE (2026 GUIDELINE)", {
    x:4.4, y:0.18, w:8.7, h:0.42,
    fontSize:12, bold:true, color:C.gold, fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.65, w:8.6, h:0.04, fill:{color:C.gold} });

  const acDuration = [
    { scenario:"Provoked (major transient — surgery, trauma)", duration:"3–6 months", rec:"Stop after 3 months if risk factor resolved", col:C.green },
    { scenario:"Provoked (minor persistent — OCP, long-haul)", duration:"≥3 months; consider extended", rec:"Reassess risk-benefit for extended therapy", col:C.yellow },
    { scenario:"Unprovoked first PE/DVT", duration:"≥3 months; consider indefinite", rec:"Low annual recurrence risk: stop; high risk: extend. DOAC preferred.", col:C.orange },
    { scenario:"Recurrent unprovoked VTE", duration:"Indefinite anticoagulation", rec:"Risk of recurrence >30% at 5 years; benefit outweighs risk", col:C.accent },
    { scenario:"Cancer-associated thrombosis (CAT)", duration:"Indefinite or until cancer resolved", rec:"LMWH or DOAC (rivaroxaban/apixaban). Edoxaban/dabigatran: ↑ GI bleed", col:C.teal },
    { scenario:"APS (Antiphospholipid Syndrome)", duration:"Indefinite", rec:"Warfarin preferred (INR 2–3); DOACs may have higher recurrence rates in triple+ve", col:C.muted },
  ];
  acDuration.forEach((r, i) => {
    slide.addShape(pres.ShapeType.rect, { x:4.4, y:0.8+i*0.85, w:0.18, h:0.75, fill:{color:r.col} });
    slide.addShape(pres.ShapeType.rect, { x:4.58, y:0.8+i*0.85, w:8.4, h:0.75, fill:{color:C.bgAlt} });
    slide.addText(r.scenario, { x:4.68, y:0.83+i*0.85, w:4.5, h:0.32, fontSize:9.5, bold:true, color:C.white, fontFace:"Calibri" });
    slide.addText(`Duration: ${r.duration}`, { x:4.68, y:1.1+i*0.85, w:4.5, h:0.32, fontSize:9, color:r.col, fontFace:"Calibri" });
    slide.addText(r.rec, { x:9.3, y:0.83+i*0.85, w:3.6, h:0.65, fontSize:8.5, color:C.muted, fontFace:"Calibri", italic:true, wrap:true });
  });

  // Post-PE syndrome
  slide.addShape(pres.ShapeType.rect, { x:4.4, y:6.05, w:8.6, h:0.04, fill:{color:C.teal} });
  slide.addText("POST-PE SYNDROME & CHRONIC FOLLOW-UP (2026 Guideline)", {
    x:4.4, y:6.15, w:8.7, h:0.38,
    fontSize:11, bold:true, color:C.teal, fontFace:"Calibri"
  });

  const followUp = [
    { title:"Dyspnoea at 3–6 months?", detail:"Echo to screen for CTEPH. V/Q scan if echo suggests PH. Exercise testing if unexplained dyspnoea." },
    { title:"Post-PE Syndrome (chronic dyspnoea/impaired QoL)", detail:"15–25% of PE survivors. Functional limitation, exercise intolerance. Supervised exercise rehab recommended." },
    { title:"Psychological: Depression/Anxiety/PTSD", detail:"Affects up to 30% of survivors. Screen and refer. Peer support programs." },
    { title:"Contraception / Pregnancy counselling", detail:"OCP contraindicated. Progestogen-only / IUD preferred. DOACs: teratogenic — switch to LMWH if pregnancy planned." },
  ];
  followUp.forEach((f, i) => {
    const x = 4.4 + (i<2 ? 0 : 4.35);
    const y = i%2===0 ? 6.6 : 7.15;
    // For last row keep y reasonable
    const yy = 6.6 + Math.floor(i/2)*0.62;
    const xx = 4.4 + (i%2)*4.35;
    slide.addShape(pres.ShapeType.rect, { x:xx, y:yy, w:4.2, h:0.55, fill:{color:C.dark} });
    slide.addShape(pres.ShapeType.rect, { x:xx, y:yy, w:0.15, h:0.55, fill:{color:C.teal} });
    slide.addText(f.title, { x:xx+0.2, y:yy+0.02, w:3.9, h:0.24, fontSize:9, bold:true, color:C.teal, fontFace:"Calibri" });
    slide.addText(f.detail, { x:xx+0.2, y:yy+0.25, w:3.9, h:0.27, fontSize:8, color:C.light, fontFace:"Calibri", wrap:true });
  });

  addBullets(slide, [
    { text:"Recurrence risk:", bold:true },
    "Provoked: 5% / year after stopping",
    "Unprovoked: 10–15% / year",
    "Recurrent unprovoked: >30% at 5yr",
    { text:"Bleeding risk (HAS-BLED, VTE-BLEED):", bold:true },
    "Age >75, renal/liver disease",
    "Prior bleeding, thrombocytopenia",
    "NSAID/antiplatelet use",
    { text:"Reversal agents:", bold:true },
    "Warfarin: Vit K + 4F-PCC",
    "Dabigatran: Idarucizumab",
    "Xa inhibitors: Andexanet alfa"
  ], 0.2, 0.8, 3.9, 6.5, 9.5, C.light);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14: KEY TAKEAWAYS
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  slide.background = { color: C.dark };
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.1, fill:{color:C.accent} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:7.4, w:13.3, h:0.1, fill:{color:C.teal} });

  slide.addText("KEY TAKEAWAYS", {
    x:0.5, y:0.2, w:12.3, h:0.6,
    fontSize:24, bold:true, color:C.white, fontFace:"Calibri", align:"center", charSpacing:4
  });
  slide.addShape(pres.ShapeType.rect, { x:3, y:0.85, w:7.3, h:0.06, fill:{color:C.gold} });

  const takeaways = [
    { num:"1", text:"PH is defined by mPAP >20 mmHg on RHC (updated from >25 mmHg). Pre-capillary PH requires BOTH PAWP ≤15 AND PVR ≥3 WU.", col:C.teal },
    { num:"2", text:"5 WHO groups: PAH (Group 1) is the target of specific therapy. CTEPH (Group 4) is the only surgically curable form.", col:C.gold },
    { num:"3", text:"PAH: Initial combination therapy ERA + PDE5i (ESC/ERS 2022, Class I-A). Sotatercept is a new add-on therapy (2024). Vasoreactivity test guides CCB use.", col:C.teal },
    { num:"4", text:"2026 AHA/ACC Guideline: NEW 5-category A–E PE classification replaces massive/submassive/low-risk — improves precision of therapy decisions.", col:C.accent },
    { num:"5", text:"PE Diagnosis: Age-adjusted D-dimer, Wells score, CTPA (gold standard). V/Q scan for CTEPH screening and pregnancy.", col:C.gold },
    { num:"6", text:"PE Treatment: DOACs preferred over warfarin. PERT for Category C3+. Systemic thrombolysis for Category E (cardiac arrest). ECMO as bridge.", col:C.accent },
    { num:"7", text:"CTEPH: Screen all PE patients at 3–6 months. V/Q scan → RHC. PTE is curative; BPA + riociguat for inoperable disease.", col:C.orange },
    { num:"8", text:"Post-PE: Screen for post-PE syndrome, CTEPH, depression/anxiety. Duration of anticoagulation depends on provoked vs unprovoked and risk factors.", col:C.green },
  ];
  takeaways.forEach((t, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
    const x = col === 0 ? 0.3 : 6.8;
    const y = 1.05 + row * 1.55;
    slide.addShape(pres.ShapeType.rect, { x, y, w:6.2, h:1.4, fill:{color:C.bg} });
    slide.addShape(pres.ShapeType.rect, { x, y, w:0.5, h:1.4, fill:{color:t.col} });
    slide.addText(t.num, { x, y, w:0.5, h:1.4, fontSize:16, bold:true, color:C.dark, fontFace:"Calibri", align:"center", valign:"middle" });
    slide.addText(t.text, { x:x+0.6, y:y+0.1, w:5.5, h:1.2, fontSize:9.5, color:C.light, fontFace:"Calibri", wrap:true, valign:"middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15: REFERENCES
// ══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
  sectionBg(slide);
  slide.addText("REFERENCES & GUIDELINES", {
    x:0.4, y:0.2, w:12.5, h:0.55,
    fontSize:20, bold:true, color:C.white, fontFace:"Calibri", align:"center"
  });
  slide.addShape(pres.ShapeType.rect, { x:1.5, y:0.8, w:10.3, h:0.06, fill:{color:C.teal} });

  const refs = [
    { tag:"[1]", text:"Humbert M et al. 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Eur Heart J. 2022;43(38):3618–3731." },
    { tag:"[2]", text:"Creager MA, Barnes GD, Giri J et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Circulation. 2026. PMID: 41712677. DOI: 10.1161/CIR.0000000000001415" },
    { tag:"[3]", text:"Mukherjee M et al. Guidelines for Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension. J Am Soc Echocardiogr. 2025. PMID: 40044341" },
    { tag:"[4]", text:"Schlager O et al. 2025 ESVM Guidelines on Interventional Treatment of Venous Thromboembolism. Vasa. 2025. PMID: 40587333" },
    { tag:"[5]", text:"Fernandes TM, Kerr KM. Chapter 86: Pulmonary Hypertension Due to Chronic Thromboembolic Disease. Murray & Nadel's Textbook of Respiratory Medicine, 2-Volume Set (9780323655873)" },
    { tag:"[6]", text:"Harrison's Principles of Internal Medicine, 21st Edition — Hemodynamic Classification of Pulmonary Hypertension" },
    { tag:"[7]", text:"AMBITION Trial: Galiè N et al. Initial Use of Ambrisentan + Tadalafil in PAH. N Engl J Med. 2015;373:834–844." },
    { tag:"[8]", text:"STELLAR Trial: Hoeper MM et al. Phase 3 Trial of Sotatercept for Treatment of PAH. N Engl J Med. 2023;388(16):1478–1490." },
    { tag:"[9]", text:"PEITHO Trial: Meyer G et al. Fibrinolysis for submassive pulmonary embolism. N Engl J Med. 2014;370(15):1402–1411." },
    { tag:"[10]", text:"CHEST-1 Trial: Ghofrani HA et al. Riociguat for the Treatment of CTEPH. N Engl J Med. 2013;369:319–329." },
  ];

  refs.forEach((r, i) => {
    const colIdx = i < 5 ? 0 : 1;
    const rowIdx = i % 5;
    slide.addText([
      { text:r.tag+" ", options:{ bold:true, color:C.gold } },
      { text:r.text, options:{ color:C.light } }
    ], {
      x:0.4+colIdx*6.45, y:1.0+rowIdx*1.15, w:6.2, h:1.05,
      fontSize:8.5, fontFace:"Calibri", wrap:true, valign:"top"
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/ph-vte-ppt/PH_VTE_PE_Residency_2026.pptx" })
  .then(() => console.log("SUCCESS: PH_VTE_PE_Residency_2026.pptx created"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });