const pptxgen = require("pptxgenjs");
const pres = new pptxgen();

pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical";
pres.title = "Myocardial Infarction";

// ─── COLOR PALETTE ──────────────────────────────────────────────────────────
const C = {
  crimson:   "B31B1B",   // dominant dark red
  darkBg:    "1A1A2E",   // near-black navy  (title / dark slides)
  midBg:     "16213E",   // dark navy
  accent:    "E94560",   // hot red-pink accent
  gold:      "F5A623",   // amber/gold for highlights
  white:     "FFFFFF",
  offWhite:  "F0F4F8",
  lightGray: "C8D6E5",
  subtleGray:"8899AA",
  cardBg:    "0F3460",   // card backgrounds
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function sectionHeader(slide, text) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: 0.7,
    fill: { color: C.crimson },
    line: { type: "none" },
  });
  slide.addText(text, {
    x: 0.4, y: 0, w: 9.2, h: 0.7,
    fontSize: 13, bold: true, color: C.white,
    valign: "middle", margin: 0,
  });
}

function slideTitle(slide, title, subtitle) {
  slide.addText(title, {
    x: 0.5, y: 0.75, w: 9, h: 0.6,
    fontSize: 26, bold: true, color: C.white, margin: 0,
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.5, y: 1.35, w: 9, h: 0.35,
      fontSize: 13, color: C.lightGray, margin: 0, italic: true,
    });
  }
}

function bulletList(slide, items, opts = {}) {
  const {
    x = 0.5, y = 1.85, w = 9, h = 3.4,
    fontSize = 14, color = C.offWhite,
    indentLevel = 0,
  } = opts;

  const textArr = items.map((item, i) => ({
    text: item.text || item,
    options: {
      bullet: { type: "bullet" },
      indentLevel: item.indent || indentLevel,
      fontSize: item.fontSize || fontSize,
      color: item.color || color,
      bold: item.bold || false,
      breakLine: i < items.length - 1,
    },
  }));
  slide.addText(textArr, { x, y, w, h, valign: "top" });
}

function addCard(slide, x, y, w, h, title, body, titleColor, bodyColor) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: C.cardBg },
    line: { color: C.accent, width: 1.5 },
    rectRadius: 0.12,
  });
  slide.addText(title, {
    x: x + 0.15, y: y + 0.08, w: w - 0.3, h: 0.38,
    fontSize: 11, bold: true, color: titleColor || C.gold, margin: 0,
  });
  slide.addText(body, {
    x: x + 0.15, y: y + 0.46, w: w - 0.3, h: h - 0.54,
    fontSize: 10, color: bodyColor || C.offWhite,
    valign: "top", wrap: true, margin: 0,
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  // Full dark background
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.darkBg }, line: { type: "none" },
  });
  // Left accent bar
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.18, h: "100%",
    fill: { color: C.crimson }, line: { type: "none" },
  });
  // Red decorative band
  sl.addShape(pres.ShapeType.rect, {
    x: 0.18, y: 2.2, w: "100%", h: 0.06,
    fill: { color: C.accent }, line: { type: "none" },
  });
  sl.addText("MYOCARDIAL", {
    x: 0.6, y: 1.0, w: 9, h: 0.9,
    fontSize: 58, bold: true, color: C.white, margin: 0, charSpacing: 4,
  });
  sl.addText("INFARCTION", {
    x: 0.6, y: 1.85, w: 9, h: 0.9,
    fontSize: 58, bold: true, color: C.accent, margin: 0, charSpacing: 4,
  });
  sl.addText("A Comprehensive Clinical Overview", {
    x: 0.6, y: 2.85, w: 8, h: 0.45,
    fontSize: 16, color: C.lightGray, italic: true, margin: 0,
  });
  sl.addText("For Clinicians & Residents  |  Based on Robbins Pathology & Braunwald's Heart Disease", {
    x: 0.6, y: 4.9, w: 9, h: 0.4,
    fontSize: 9.5, color: C.subtleGray, margin: 0,
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW & EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "OVERVIEW & EPIDEMIOLOGY");
  slideTitle(sl, "What is Myocardial Infarction?");

  sl.addText([
    { text: "Definition: ", options: { bold: true, color: C.gold } },
    { text: "Necrosis of cardiac muscle due to prolonged ischemia, most commonly from acute coronary artery thrombosis following atherosclerotic plaque disruption.", options: { color: C.offWhite } },
  ], { x: 0.5, y: 1.8, w: 9, h: 0.65, fontSize: 13 });

  // Stat cards row
  addCard(sl, 0.3, 2.65, 2.8, 1.5, "~800,000 / year", "MIs occur annually in the United States — nearly one every 40 seconds", C.accent, C.lightGray);
  addCard(sl, 3.35, 2.65, 2.8, 1.5, "~400,000 deaths", "Annual US mortality attributable to acute MI", C.accent, C.lightGray);
  addCard(sl, 6.4, 2.65, 2.8, 1.5, "10% under 40 yrs", "45% of MIs occur before age 65. Frequency rises with age & risk factors", C.accent, C.lightGray);

  bulletList(sl, [
    { text: "Atherosclerosis is the major underlying cause in >90% of cases", bold: false },
    { text: "Male sex increases relative risk; gap narrows post-menopause", bold: false },
    { text: "Postmenopausal women: IHD is the most common cause of death", bold: false },
    { text: "Non-atherosclerotic causes (~10%): vasospasm, embolism (AF, valve vegetations), vasculitis", bold: false },
  ], { x: 0.5, y: 4.3, w: 9, h: 1.15, fontSize: 12 });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — PATHOGENESIS & CORONARY ARTERY OCCLUSION
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "PATHOGENESIS");
  slideTitle(sl, "Coronary Artery Occlusion — Step-by-Step");

  const steps = [
    { num: "1", text: "Atheromatous plaque erosion or disruption exposes subendothelial collagen & necrotic plaque contents to blood" },
    { num: "2", text: "Platelet adhesion, aggregation & activation — release of TXA₂, ADP, serotonin → further platelet aggregation & vasospasm" },
    { num: "3", text: "Coagulation cascade activated by tissue factor exposure → expanding thrombus" },
    { num: "4", text: "Within minutes, thrombus can completely occlude the coronary lumen" },
    { num: "5", text: "Angiography within 4 hrs shows thrombosis in ~90% of MI cases; after 12–24 hrs only 60% (some resolve spontaneously)" },
  ];

  steps.forEach((s, i) => {
    const yPos = 1.72 + i * 0.72;
    sl.addShape(pres.ShapeType.ellipse, {
      x: 0.3, y: yPos, w: 0.42, h: 0.42,
      fill: { color: C.crimson }, line: { type: "none" },
    });
    sl.addText(s.num, {
      x: 0.3, y: yPos, w: 0.42, h: 0.42,
      fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0,
    });
    sl.addText(s.text, {
      x: 0.85, y: yPos + 0.02, w: 8.8, h: 0.5,
      fontSize: 12, color: C.offWhite, valign: "middle", margin: 0,
    });
    if (i < steps.length - 1) {
      sl.addShape(pres.ShapeType.line, {
        x: 0.51, y: yPos + 0.43, w: 0, h: 0.29,
        line: { color: C.accent, width: 1.5 },
      });
    }
  });

  sl.addText("Key: Most MIs arise from plaques causing <70% stenosis prior to rupture (not \"critical\" lesions)", {
    x: 0.5, y: 5.2, w: 9, h: 0.32,
    fontSize: 10.5, italic: true, color: C.gold, margin: 0,
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — CLASSIFICATION: STEMI vs NSTEMI
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "CLASSIFICATION");
  slideTitle(sl, "STEMI vs NSTEMI vs Unstable Angina");

  // STEMI box
  sl.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 1.75, w: 2.85, h: 3.6,
    fill: { color: "3B0000" }, line: { color: C.crimson, width: 2 },
    rectRadius: 0.12,
  });
  sl.addText("STEMI", {
    x: 0.3, y: 1.75, w: 2.85, h: 0.5,
    fontSize: 16, bold: true, color: C.crimson, align: "center", margin: 0,
  });
  bulletList(sl, [
    "ST-elevation on ECG",
    "Complete occlusion",
    "Full-thickness infarct (transmural)",
    "Troponin markedly elevated",
    "Requires urgent reperfusion",
    "Higher immediate mortality",
  ], { x: 0.4, y: 2.3, w: 2.65, h: 2.9, fontSize: 11, color: C.lightGray });

  // NSTEMI box
  sl.addShape(pres.ShapeType.roundRect, {
    x: 3.4, y: 1.75, w: 2.85, h: 3.6,
    fill: { color: "001A3B" }, line: { color: C.accent, width: 2 },
    rectRadius: 0.12,
  });
  sl.addText("NSTEMI", {
    x: 3.4, y: 1.75, w: 2.85, h: 0.5,
    fontSize: 16, bold: true, color: C.accent, align: "center", margin: 0,
  });
  bulletList(sl, [
    "No ST-elevation",
    "Partial or transient occlusion",
    "Subendocardial infarct",
    "Troponin elevated",
    "Urgent risk stratification",
    "Requires antithrombotic Rx",
  ], { x: 3.5, y: 2.3, w: 2.65, h: 2.9, fontSize: 11, color: C.lightGray });

  // Unstable Angina box
  sl.addShape(pres.ShapeType.roundRect, {
    x: 6.5, y: 1.75, w: 2.85, h: 3.6,
    fill: { color: "001A1A" }, line: { color: C.gold, width: 2 },
    rectRadius: 0.12,
  });
  sl.addText("UNSTABLE ANGINA", {
    x: 6.5, y: 1.75, w: 2.85, h: 0.5,
    fontSize: 13.5, bold: true, color: C.gold, align: "center", margin: 0,
  });
  bulletList(sl, [
    "No ST-elevation",
    "Plaque disruption + thrombus",
    "No troponin rise",
    "Harbinger of MI",
    "Risk stratify urgently",
    "ACS pathway activation",
  ], { x: 6.6, y: 2.3, w: 2.65, h: 2.9, fontSize: 11, color: C.lightGray });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — CLINICAL FEATURES & DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "CLINICAL PRESENTATION & DIAGNOSIS");
  slideTitle(sl, "Recognition of Acute MI");

  // Symptoms column
  sl.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 1.7, w: 4.4, h: 3.75,
    fill: { color: C.cardBg }, line: { color: C.crimson, width: 1.5 },
    rectRadius: 0.12,
  });
  sl.addText("Symptoms", {
    x: 0.45, y: 1.75, w: 4.1, h: 0.4,
    fontSize: 14, bold: true, color: C.gold, margin: 0,
  });
  bulletList(sl, [
    "Severe, crushing central chest pain (>20 min)",
    "Radiation to left arm, jaw, neck, back",
    "Diaphoresis, nausea, vomiting",
    "Dyspnea, sense of impending doom",
    "Silent MI: especially in diabetics & elderly",
    "Atypical: epigastric pain, fatigue (women)",
  ], { x: 0.45, y: 2.2, w: 4.1, h: 3.0, fontSize: 12, color: C.offWhite });

  // Investigations column
  sl.addShape(pres.ShapeType.roundRect, {
    x: 5.0, y: 1.7, w: 4.6, h: 3.75,
    fill: { color: C.cardBg }, line: { color: C.accent, width: 1.5 },
    rectRadius: 0.12,
  });
  sl.addText("Investigations", {
    x: 5.15, y: 1.75, w: 4.3, h: 0.4,
    fontSize: 14, bold: true, color: C.gold, margin: 0,
  });
  bulletList(sl, [
    { text: "ECG (12-lead):", bold: true },
    { text: "  ST elevation (STEMI) | T-wave inversion | new LBBB", indent: 1 },
    { text: "Cardiac Biomarkers:", bold: true },
    { text: "  Troponin I/T — rises 3–6 hrs, peaks 12–24 hrs; gold standard", indent: 1 },
    { text: "  CK-MB — rises 4–8 hrs; useful for reinfarction", indent: 1 },
    { text: "Imaging:", bold: true },
    { text: "  Echo: wall motion abnormalities, EF assessment", indent: 1 },
    { text: "  Coronary angiography: definitive anatomy", indent: 1 },
  ], { x: 5.15, y: 2.2, w: 4.3, h: 3.1, fontSize: 11.5, color: C.offWhite });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — MORPHOLOGIC EVOLUTION (timeline table)
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "PATHOLOGY");
  slideTitle(sl, "Morphologic Evolution of Myocardial Infarction");

  const rows = [
    ["Time", "Gross Features", "Light Microscopy"],
    ["0–0.5 hr", "None visible", "Normal; mitochondrial swelling (EM)"],
    ["0.5–4 hr", "None", "Wavy fibers at border (occasional)"],
    ["4–12 hr", "Dark mottling (occasional)", "Early coagulative necrosis; edema; hemorrhage"],
    ["12–24 hr", "Dark mottling", "Coagulative necrosis; nuclear pyknosis; neutrophilic infiltrate begins"],
    ["1–3 days", "Mottling; yellow-tan centre", "Loss of nuclei & striations; brisk neutrophil infiltrate"],
    ["3–7 days", "Yellow-tan, soft; hyperemic rim", "Macrophage infiltration; dissolving fibres (risk of rupture)"],
    ["1–3 wks", "Gray-white, firm edges", "Granulation tissue; fibroblast proliferation"],
    ["Months", "White fibrous scar", "Dense collagen scar; complete remodelling"],
  ];

  const colW = [1.45, 3.55, 4.55];
  const colX = [0.25, 1.7, 5.25];
  const rowH = 0.49;
  const startY = 1.65;

  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const isHeader = ri === 0;
      sl.addShape(pres.ShapeType.rect, {
        x: colX[ci], y: startY + ri * rowH,
        w: colW[ci], h: rowH,
        fill: { color: isHeader ? C.crimson : (ri % 2 === 0 ? C.cardBg : "0B2545") },
        line: { color: "334466", width: 0.5 },
      });
      sl.addText(cell, {
        x: colX[ci] + 0.07, y: startY + ri * rowH,
        w: colW[ci] - 0.14, h: rowH,
        fontSize: isHeader ? 11 : 10,
        color: isHeader ? C.white : (ci === 0 ? C.gold : C.offWhite),
        bold: isHeader,
        valign: "middle", margin: 0, wrap: true,
      });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — INFARCT LOCATION & TERRITORY
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "INFARCT TERRITORY");
  slideTitle(sl, "Coronary Artery Territories & Affected Regions");

  const arteries = [
    {
      name: "LAD (Left Anterior Descending)",
      territory: "Anterior wall LV, anterior 2/3 of septum, apex",
      notes: "Most common infarct-related artery; anterior STEMI",
      color: C.crimson,
    },
    {
      name: "RCA (Right Coronary Artery)",
      territory: "Inferior/posterior wall LV, posterior septum, RV",
      notes: "Inferior STEMI; may cause AV block; RV infarction in 15–30%",
      color: C.accent,
    },
    {
      name: "LCx (Left Circumflex)",
      territory: "Lateral & posterolateral wall LV",
      notes: "Lateral STEMI; often ECG-silent (posterior leads needed)",
      color: C.gold,
    },
  ];

  arteries.forEach((a, i) => {
    const yPos = 1.8 + i * 1.25;
    sl.addShape(pres.ShapeType.roundRect, {
      x: 0.3, y: yPos, w: 9.1, h: 1.1,
      fill: { color: C.cardBg }, line: { color: a.color, width: 2 },
      rectRadius: 0.12,
    });
    sl.addText(a.name, {
      x: 0.5, y: yPos + 0.08, w: 3.5, h: 0.4,
      fontSize: 13, bold: true, color: a.color, margin: 0,
    });
    sl.addText("Territory: " + a.territory, {
      x: 0.5, y: yPos + 0.5, w: 5.5, h: 0.35,
      fontSize: 11, color: C.lightGray, margin: 0,
    });
    sl.addText(a.notes, {
      x: 5.5, y: yPos + 0.1, w: 3.7, h: 0.9,
      fontSize: 10.5, color: C.offWhite, italic: true, valign: "middle", wrap: true, margin: 0,
    });
  });

  sl.addText("Note: Isolated RV infarction is rare (1–3%). Atrial infarction is uncommon.", {
    x: 0.5, y: 5.55, w: 9, h: 0.35,
    fontSize: 10.5, italic: true, color: C.subtleGray, margin: 0,
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — COMPLICATIONS
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "COMPLICATIONS");
  slideTitle(sl, "Post-MI Complications");

  const comps = [
    {
      title: "Arrhythmias (most common)",
      body: "~90% of patients. VF greatest risk in first hour. Includes heart block, VT, SVT, asystole.",
      color: C.crimson,
    },
    {
      title: "Myocardial Rupture (1–3%)",
      body: "Free wall → tamponade; Septal → VSD; Papillary muscle → acute MR. Peak risk: days 3–7.",
      color: C.accent,
    },
    {
      title: "LV Failure / Cardiogenic Shock",
      body: "Occurs with large infarcts. Progressive pump failure; 40–50% of ventricle loss → shock.",
      color: C.gold,
    },
    {
      title: "Pericarditis",
      body: "2–3 days post-MI. Friction rub, pleuritic chest pain. Dressler syndrome weeks later (autoimmune).",
      color: "4FC3F7",
    },
    {
      title: "Mural Thrombus & Embolism",
      body: "Wall motion abnormality + stasis. Risk of systemic embolism; anticoagulation indicated.",
      color: "80CBC4",
    },
    {
      title: "LV Aneurysm",
      body: "Late complication. Paradoxical bulge, persistent ST elevation, arrhythmias, CHF, thrombus.",
      color: "CE93D8",
    },
  ];

  const cols = 3;
  const cardW = 2.9;
  const cardH = 1.4;
  const gapX = 0.25;
  const gapY = 0.22;
  const startX = 0.3;
  const startY = 1.75;

  comps.forEach((c, i) => {
    const col = i % cols;
    const row = Math.floor(i / cols);
    const x = startX + col * (cardW + gapX);
    const y = startY + row * (cardH + gapY);

    sl.addShape(pres.ShapeType.roundRect, {
      x, y, w: cardW, h: cardH,
      fill: { color: C.cardBg }, line: { color: c.color, width: 1.5 },
      rectRadius: 0.12,
    });
    sl.addText(c.title, {
      x: x + 0.12, y: y + 0.1, w: cardW - 0.24, h: 0.36,
      fontSize: 11, bold: true, color: c.color, margin: 0,
    });
    sl.addText(c.body, {
      x: x + 0.12, y: y + 0.48, w: cardW - 0.24, h: cardH - 0.56,
      fontSize: 10, color: C.offWhite, valign: "top", wrap: true, margin: 0,
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — MANAGEMENT: IMMEDIATE
// ═══════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: "100%",
    fill: { color: C.midBg }, line: { type: "none" },
  });
  sectionHeader(sl, "MANAGEMENT");
  slideTitle(sl, "Immediate Management of ACS");

  // MONA + acronym display
  const monaItems = [
    { letter: "M", word: "Morphine", desc: "IV opioid analgesia — use judiciously (may mask symptoms)" },
    { letter: "O", word: "Oxygen", desc: "Supplemental O₂ if SpO₂ <94% (avoid hyperoxia)" },
    { letter: "N", word: "Nitrates", desc: "Sublingual/IV GTN for pain relief & preload reduction" },
    { letter: "A", word: "Aspirin", desc: "300 mg loading dose immediately; indefinite 75–100 mg/day" },
  ];

  sl.addText("Initial Pharmacotherapy", {
    x: 0.4, y: 1.7, w: 4.5, h: 0.4,
    fontSize: 14, bold: true, color: C.gold, margin: 0,
  });

  monaItems.forEach((m, i) => {
    const y = 2.15 + i * 0.77;
    sl.addShape(pres.ShapeType.rect, {
      x: 0.35, y, w: 0.45, h: 0.55,
      fill: { color: C.crimson }, line: { type: "none" },
    });
    sl.addText(m.letter, {
      x: 0.35, y, w: 0.45, h: 0.55,
      fontSize: 18, bold: true, color: C.white, align: "center", valign: "middle", margin: 0,
    });
    sl.addText(m.word + ": ", {
      x: 0.9, y: y + 0.03, w: 4.2, h: 0.28,
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    { text: "P2Y12 inhibitor (clopidogrel / ticagrelor / prasugrel) — dual antiplatelet", bold: false },
    { text: "Anticoagulation: UFH, LMWH (enoxaparin), or fondaparinux", bold: false },
    { text: "Beta-blockers (metoprolol): reduce HR, O₂ demand, arrhythmia risk", bold: false },
    { text: "ACE inhibitor: early initiation post-MI, especially anterior STEMI", bold: false },
    { text: "High-intensity statin: atorvastatin 80 mg — plaque stabilisation", bold: false },
    { text: "GPIIb/IIIa inhibitors: PCI adjunct in high-risk NSTEMI", bold: false },
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}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — REPERFUSION STRATEGIES
// ═══════════════════════════════════════════════════════════════════════════
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  slideTitle(sl, "Restoring Coronary Flow — Time is Muscle");

  sl.addText('"Time is muscle" — each minute of ischemia = irreversible cardiomyocyte loss', {
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    "Gold standard for STEMI if PCI-capable centre within 90 min",
    "Door-to-balloon time goal: ≤90 minutes",
    "Restores TIMI 3 flow in >90% of cases",
    "Superior to thrombolysis: lower mortality, reinfarction, stroke",
    "Also preferred in cardiogenic shock, failed thrombolysis",
    "Radial access preferred: lower bleeding risk",
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    "Administer if PCI cannot be achieved within 120 min of FMC",
    "Agents: alteplase, tenecteplase, reteplase",
    "Door-to-needle time: ≤30 minutes",
    "Contraindicated: prior haemorrhagic stroke, recent surgery, uncontrolled HTN",
    "If successful → pharmacoinvasive strategy: angiography within 24 hrs",
    "If failed → rescue PCI",
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  sl.addText("Reperfusion injury: paradoxical myocardial damage on restoration of blood flow — mitochondrial Ca²⁺ overload, ROS generation, no-reflow phenomenon", {
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — SECONDARY PREVENTION
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  sectionHeader(sl, "SECONDARY PREVENTION");
  slideTitle(sl, "Post-MI Long-term Management");

  const drugs = [
    { drug: "Aspirin", dose: "75–100 mg OD lifelong", reason: "Antiplatelet — prevents reinfarction" },
    { drug: "P2Y12 Inhibitor", dose: "Dual therapy for 12 months (ticagrelor/prasugrel preferred post-PCI)", reason: "DAPT reduces stent thrombosis & recurrent ACS" },
    { drug: "Beta-Blocker", dose: "Lifelong if LV dysfunction present (EF <40%)", reason: "Reduces mortality, sudden death, arrhythmias" },
    { drug: "ACE Inhibitor / ARB", dose: "All post-MI patients, especially with LV dysfunction or DM", reason: "Prevents cardiac remodelling, reduces CHF" },
    { drug: "High-Intensity Statin", dose: "Atorvastatin 40–80 mg or rosuvastatin 20–40 mg", reason: "LDL target <1.4 mmol/L; plaque stabilisation" },
    { drug: "Eplerenone / Spironolactone", dose: "Post-MI EF ≤40% + HF or DM", reason: "Aldosterone antagonist — reduces mortality" },
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — PROGNOSIS & RISK STRATIFICATION
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  slideTitle(sl, "Predictors of Outcome Post-MI");

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    "Delayed reperfusion (>6 hrs)",
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    { text: "  7-variable score; predicts 30-day mortality", indent: 1 },
    { text: "GRACE Score:", bold: true },
    { text: "  Age, HR, BP, Cr, Killip class, cardiac arrest, ST deviation, troponin", indent: 1 },
    { text: "Killip Classification:", bold: true },
    { text: "  Class I–IV: correlates with 30-day mortality (I: ~6% → IV: ~80%)", indent: 1 },
    { text: "Follow-up Echo at 6–12 weeks to assess for LV remodelling", bold: false },
    { text: "Cardiac MRI: gold standard for viability & scar assessment", bold: false },
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — SPECIAL POPULATIONS
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  slideTitle(sl, "MI in Special Populations");

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      title: "Women",
      points: [
        "Atypical presentation: fatigue, nausea, jaw/back pain",
        "Under-represented in trials historically",
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        "Spontaneous coronary artery dissection (SCAD) — young women",
        "Postmenopausal decline in oestrogen → ↑ risk",
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    {
      title: "Diabetics",
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        "Silent / painless MI more common",
        "Larger infarcts, more multivessel disease",
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        "Tight glycaemic control post-MI may reduce events",
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        "Atypical symptoms: dyspnoea, syncope, confusion",
        "Higher procedural risk but benefit from PCI preserved",
        "Bleeding risk — dose adjustment for anticoagulants",
        "Frailty assessment influences treatment intensity",
        "Polypharmacy and renal function require close monitoring",
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — KEY CONCEPTS SUMMARY
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  slideTitle(sl, "Key Concepts — Myocardial Infarction");

  const keyPoints = [
    "MI = necrosis of cardiac muscle from prolonged ischemia; most commonly caused by acute coronary thrombosis on a disrupted atherosclerotic plaque.",
    "Plaque rupture activates platelets (TXA₂, ADP) and coagulation cascade → within minutes can completely occlude the lumen.",
    "Loss of cardiac function occurs within 1–2 min of ischemia; irreversible necrosis begins after 20–30 min.",
    "Classified as STEMI (transmural; complete occlusion) or NSTEMI (subendocardial; partial occlusion).",
    "Diagnosis: clinical features + ECG changes + cardiac troponins (rise 3–6 hrs; peak 12–24 hrs).",
    "Complications: arrhythmias (~90%), rupture (1–3%), LV failure, pericarditis, aneurysm, mural thrombus.",
    "Reperfusion: primary PCI preferred (door-to-balloon ≤90 min); thrombolysis if PCI not available within 120 min.",
    "Secondary prevention: DAPT, beta-blocker, ACEi/ARB, high-dose statin, aldosterone antagonist if EF ≤40%.",
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — REFERENCES
// ═══════════════════════════════════════════════════════════════════════════
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  const refs = [
    "Kumar V, Abbas AK, Aster JC. Robbins & Kumar Basic Pathology, 11th ed. Elsevier, 2023.",
    "Kumar V et al. Robbins, Cotran & Kumar Pathologic Basis of Disease, 10th ed. Elsevier, 2021.",
    "Libby P, Bonow RO et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 12th ed. Elsevier, 2022.",
    "Goldman L, Schafer AI. Goldman-Cecil Medicine, 27th ed. Elsevier, 2024.",
    "Fuster V et al. Fuster and Hurst's The Heart, 15th ed. McGraw-Hill, 2022.",
    "Collet JP et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment elevation. Eur Heart J. 2021;42(14):1289–1367.",
    "Ibanez B et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119–177.",
  ];

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// ─── WRITE FILE ───────────────────────────────────────────────────────────
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