ECG electrocardiogram myocardial infarction ST elevation

atrial fibrillation ECG irregular rhythm no P wave

ventricular tachycardia ECG wide complex tachycardia

complete heart block third degree AV block ECG P waves QRS dissociation

hyperkalemia peaked T waves ECG sine wave pattern

pulmonary embolism ECG S1Q3T3 pattern right heart strain

Wolff-Parkinson-White syndrome ECG delta wave short PR interval

left ventricular hypertrophy ECG high voltage Sokolow-Lyon criteria

pericarditis ECG saddle shaped ST elevation diffuse

ls /home/daytona/workspace/ 2>/dev/null && python3 -c "import PIL; print('PIL ve…

ls /home/daytona/workspace/

mkdir -p /tmp/ecg_annotated && python3 -c "from PIL import Image, ImageDraw, Ima…

/tmp/ecg_annotate.py

import requests
from PIL import Image, ImageDraw, ImageFont
from io import BytesIO
import os

OUT = "/tmp/ecg_annotated"
os.makedirs(OUT, exist_ok=True)

def download(url):
    r = requests.get(url, timeout=20)
    return Image.open(BytesIO(r.content)).convert("RGB")

def draw_arrow(draw, start, end, color, width=4):
    """Draw a line with arrowhead"""
    import math
    draw.line([start, end], fill=color, width=width)
    # Arrowhead
    angle = math.atan2(end[1]-start[1], end[0]-start[0])
    arrow_len = 18
    arrow_angle = math.pi/6
    x1 = end[0] - arrow_len*math.cos(angle - arrow_angle)
    y1 = end[1] - arrow_len*math.sin(angle - arrow_angle)
    x2 = end[0] - arrow_len*math.cos(angle + arrow_angle)
    y2 = end[1] - arrow_len*math.sin(angle + arrow_angle)
    draw.polygon([end, (x1,y1), (x2,y2)], fill=color)

def draw_label_box(draw, xy, text, bg_color, text_color="white", font=None):
    """Draw a filled box with text"""
    if font:
        bbox = draw.textbbox(xy, text, font=font)
    else:
        bbox = draw.textbbox(xy, text)
    pad = 6
    draw.rounded_rectangle(
        [bbox[0]-pad, bbox[1]-pad, bbox[2]+pad, bbox[3]+pad],
        radius=6, fill=bg_color
    )
    if font:
        draw.text(xy, text, fill=text_color, font=font)
    else:
        draw.text(xy, text, fill=text_color)

def draw_circle_highlight(draw, center, radius, color, width=4):
    x, y = center
    draw.ellipse([x-radius, y-radius, x+radius, y+radius], outline=color, width=width)

def draw_rect_highlight(draw, box, color, width=4):
    draw.rectangle(box, outline=color, width=width)

def add_title_bar(img, title, subtitle=""):
    """Add a colored title bar at bottom"""
    w, h = img.size
    bar_h = 70 if subtitle else 45
    new_img = Image.new("RGB", (w, h + bar_h), (30, 30, 30))
    new_img.paste(img, (0, 0))
    draw = ImageDraw.Draw(new_img)
    try:
        font_big = ImageFont.truetype("/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf", 20)
        font_small = ImageFont.truetype("/usr/share/fonts/truetype/dejavu/DejaVuSans.ttf", 15)
    except:
        font_big = font_small = None
    draw.text((10, h+5), title, fill=(255, 220, 50), font=font_big)
    if subtitle:
        draw.text((10, h+32), subtitle, fill=(180, 180, 180), font=font_small)
    return new_img

try:
    font_label = ImageFont.truetype("/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf", 18)
    font_small = ImageFont.truetype("/usr/share/fonts/truetype/dejavu/DejaVuSans.ttf", 15)
except:
    font_label = font_small = None

# ─────────────────────────────────────────────
# 1. STEMI — Anterior
# ─────────────────────────────────────────────
print("Processing STEMI...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_16738d4b125195130b5e53a811645d4064182fc2bbd0de16b0e00a57af7ff6ef.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# ST elevation area in V2-V4 (approximately upper-middle precordial zone)
# Draw highlight boxes over V2, V3, V4 leads (precordial leads roughly right half)
draw_rect_highlight(draw, [int(w*0.52), int(h*0.05), int(w*0.75), int(h*0.52)], "#FF2200", width=5)
draw_label_box(draw, (int(w*0.53), int(h*0.06)), "ST ELEVATION (V2-V4)", "#FF2200", font=font_label)
draw_arrow(draw, (int(w*0.62), int(h*0.15)), (int(w*0.62), int(h*0.28)), "#FF2200", width=4)

# Reciprocal changes in inferior leads (left side, lower)
draw_rect_highlight(draw, [int(w*0.05), int(h*0.55), int(w*0.30), int(h*0.88)], "#FF8800", width=4)
draw_label_box(draw, (int(w*0.05), int(h*0.56)), "RECIPROCAL DEPRESSION", "#FF8800", font=font_small)

img = add_title_bar(img, "1. STEMI (Anterior) — ECG Findings", "ST Elevation: V2-V4 | Reciprocal Depression: II, III, aVF")
img.save(f"{OUT}/01_stemi.jpg", quality=92)
print("  STEMI done")

# ─────────────────────────────────────────────
# 2. Atrial Fibrillation
# ─────────────────────────────────────────────
print("Processing AF...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_a8e7a35a18d282cc6de8c169a0213a6712f9fe9e4a7253f7828e22c867033097.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Highlight irregular R-R intervals with vertical lines
rr_x = [int(w*0.12), int(w*0.22), int(w*0.30), int(w*0.41), int(w*0.50), int(w*0.62), int(w*0.73), int(w*0.82)]
for x in rr_x:
    draw.line([(x, int(h*0.1)), (x, int(h*0.9))], fill="#00CC00", width=2)

# Label R-R irregular
draw_label_box(draw, (int(w*0.05), int(h*0.04)), "IRREGULAR R-R INTERVALS (No fixed pattern)", "#00880000"[:8]+"008800", "#00AA00", "white", font=font_small)
draw_label_box(draw, (int(w*0.05), int(h*0.04)), "IRREGULAR R-R INTERVALS", "#005500", font=font_small)

# Highlight fibrillatory baseline (between QRS complexes)
draw_rect_highlight(draw, [int(w*0.53), int(h*0.35), int(w*0.62), int(h*0.65)], "#FFFF00", width=3)
draw_label_box(draw, (int(w*0.54), int(h*0.66)), "f-waves (No P waves)", "#996600", font=font_small)

# Arrow pointing to absent P wave zone
draw_arrow(draw, (int(w*0.35), int(h*0.22)), (int(w*0.20), int(h*0.42)), "#FF4400", width=3)
draw_label_box(draw, (int(w*0.30), int(h*0.16)), "NO P WAVE HERE", "#CC2200", font=font_small)

img = add_title_bar(img, "2. Atrial Fibrillation (AF) — ECG Findings", "No P waves | Irregular R-R | Fibrillatory (f) baseline")
img.save(f"{OUT}/02_af.jpg", quality=92)
print("  AF done")

# ─────────────────────────────────────────────
# 3. Ventricular Tachycardia
# ─────────────────────────────────────────────
print("Processing VT...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_78d0f5258907aeaa1cef17f4e48eb67e9b662997f68b1a45344ef653aa0e5ada.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Wide QRS — highlight one complex
draw_rect_highlight(draw, [int(w*0.25), int(h*0.08), int(w*0.42), int(h*0.55)], "#FF2200", width=5)
draw_label_box(draw, (int(w*0.25), int(h*0.58)), "WIDE QRS >120ms", "#FF2200", font=font_label)

# Another QRS
draw_rect_highlight(draw, [int(w*0.55), int(h*0.08), int(w*0.70), int(h*0.55)], "#FF2200", width=4)

# Fast rate indicator
draw_arrow(draw, (int(w*0.10), int(h*0.15)), (int(w*0.82), int(h*0.15)), "#FF8800", width=3)
draw_label_box(draw, (int(w*0.32), int(h*0.06)), "FAST RATE ~116 bpm", "#996600", font=font_small)

# No P waves label
draw_label_box(draw, (int(w*0.05), int(h*0.70)), "NO VISIBLE P WAVES (AV Dissociation)", "#880055", font=font_small)
draw_arrow(draw, (int(w*0.38), int(h*0.75)), (int(w*0.38), int(h*0.88)), "#880055", width=3)

img = add_title_bar(img, "3. Ventricular Tachycardia (VT) — ECG Findings", "Wide QRS >120ms | Fast rate | No P waves | AV Dissociation")
img.save(f"{OUT}/03_vt.jpg", quality=92)
print("  VT done")

# ─────────────────────────────────────────────
# 4. Complete Heart Block
# ─────────────────────────────────────────────
print("Processing CHB...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e815dc24a460bb845ac47baf936d46861eadc98131a930e5ce2dea5437cf2f45.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# P waves — mark several (top part of trace, small bumps)
p_positions = [int(w*0.08), int(w*0.18), int(w*0.28), int(w*0.40), int(w*0.52), int(w*0.63), int(w*0.75), int(w*0.87)]
for px in p_positions:
    draw_circle_highlight(draw, (px, int(h*0.38)), 18, "#0088FF", width=3)

draw_label_box(draw, (int(w*0.35), int(h*0.08)), "P WAVES (Atrial — fast, regular)", "#0044CC", font=font_small)
draw_arrow(draw, (int(w*0.40), int(h*0.15)), (int(w*0.40), int(h*0.35)), "#0044CC", width=3)

# QRS complexes — mark them (taller, less frequent)
qrs_positions = [int(w*0.15), int(w*0.42), int(w*0.68), int(w*0.90)]
for qx in qrs_positions:
    draw_rect_highlight(draw, [qx-15, int(h*0.42), qx+15, int(h*0.80)], "#FF2200", width=3)

draw_label_box(draw, (int(w*0.05), int(h*0.82)), "QRS (Ventricular escape — slow, independent)", "#CC2200", font=font_small)

# Show dissociation with "≠" symbol
draw_label_box(draw, (int(w*0.35), int(h*0.55)), "P ≠ QRS  (Complete Dissociation!)", "#8800CC", font=font_label)

img = add_title_bar(img, "4. Complete Heart Block (3° AV Block)", "P waves (fast) & QRS (slow) completely independent — AV Dissociation")
img.save(f"{OUT}/04_chb.jpg", quality=92)
print("  CHB done")

# ─────────────────────────────────────────────
# 5. Pulmonary Embolism — S1Q3T3
# ─────────────────────────────────────────────
print("Processing PE...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5f391caa5a24ec425e9f48d4d9f73620a3b91f98df1f92cea400318772fda12e.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# S wave in Lead I (left part, Lead I)
draw_circle_highlight(draw, (int(w*0.14), int(h*0.60)), 30, "#FF2200", width=4)
draw_label_box(draw, (int(w*0.03), int(h*0.72)), "S wave (Lead I)", "#CC0000", font=font_label)
draw_arrow(draw, (int(w*0.10), int(h*0.71)), (int(w*0.12), int(h*0.62)), "#CC0000", width=3)

# Q wave in Lead III
draw_circle_highlight(draw, (int(w*0.28), int(h*0.62)), 28, "#0088FF", width=4)
draw_label_box(draw, (int(w*0.23), int(h*0.76)), "Q wave (Lead III)", "#0044CC", font=font_label)
draw_arrow(draw, (int(w*0.28), int(h*0.75)), (int(w*0.28), int(h*0.65)), "#0044CC", width=3)

# T inversion in Lead III
draw_circle_highlight(draw, (int(w*0.33), int(h*0.45)), 25, "#00AA00", width=4)
draw_label_box(draw, (int(w*0.28), int(h*0.30)), "T INVERSION (Lead III)", "#006600", font=font_label)
draw_arrow(draw, (int(w*0.33), int(h*0.32)), (int(w*0.33), int(h*0.42)), "#006600", width=3)

# Overall S1Q3T3 label
draw_label_box(draw, (int(w*0.38), int(h*0.08)), "S1Q3T3 PATTERN — Acute PE Sign!", "#AA5500", font=font_label)

img = add_title_bar(img, "5. Pulmonary Embolism (PE) — S1Q3T3 Pattern", "S wave Lead I | Q wave Lead III | T inversion Lead III")
img.save(f"{OUT}/05_pe.jpg", quality=92)
print("  PE done")

# ─────────────────────────────────────────────
# 6. Hyperkalemia
# ─────────────────────────────────────────────
print("Processing Hyperkalemia...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_fe2f65ae40a819efc8e66d21477f1d7e86de436ec5daf282d24b8f53d08be4a6.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Peaked T waves in V2, V3 precordial leads
# Highlight T-wave peaks
t_positions = [int(w*0.55), int(w*0.65), int(w*0.73)]
for tx in t_positions:
    draw_circle_highlight(draw, (tx, int(h*0.30)), 28, "#FF2200", width=4)
    draw_arrow(draw, (tx, int(h*0.12)), (tx, int(h*0.24)), "#FF2200", width=3)

draw_label_box(draw, (int(w*0.48), int(h*0.04)), "PEAKED (TENTED) T WAVES", "#CC0000", font=font_label)
draw_label_box(draw, (int(w*0.50), int(h*0.13)), "Narrow base, tall height = Hyperkalemia", "#880000", font=font_small)

# Highlight normal PR / normal P waves for comparison
draw_rect_highlight(draw, [int(w*0.50), int(h*0.45), int(w*0.80), int(h*0.70)], "#0088FF", width=3)
draw_label_box(draw, (int(w*0.50), int(h*0.71)), "P waves still visible (early stage)", "#004499", font=font_small)

img = add_title_bar(img, "6. Hyperkalemia — ECG Findings (K+ 7.3 mEq/L)", "PEAKED T waves in V2-V3 | Narrow base = Classic early Hyperkalemia sign")
img.save(f"{OUT}/06_hyperkalemia.jpg", quality=92)
print("  Hyperkalemia done")

# ─────────────────────────────────────────────
# 7. WPW Syndrome
# ─────────────────────────────────────────────
print("Processing WPW...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_fd0d58cc1913acd56cbc62cbf42657e4a465f052a9bb2ea0d3893584ef6f70e6.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Short PR interval — first few complexes
draw_rect_highlight(draw, [int(w*0.06), int(h*0.30), int(w*0.18), int(h*0.55)], "#FF8800", width=4)
draw_label_box(draw, (int(w*0.04), int(h*0.58)), "SHORT PR (<120ms)", "#995500", font=font_label)

# Delta wave — slurred upstroke of QRS
# Highlight beginning of QRS complexes
delta_positions = [int(w*0.10), int(w*0.24), int(w*0.38), int(w*0.52), int(w*0.66), int(w*0.80)]
for dx in delta_positions:
    draw_rect_highlight(draw, [dx-10, int(h*0.42), dx+8, int(h*0.62)], "#FF2200", width=3)

draw_label_box(draw, (int(w*0.35), int(h*0.08)), "DELTA WAVES (Slurred QRS onset)", "#CC0000", font=font_label)
draw_arrow(draw, (int(w*0.38), int(h*0.15)), (int(w*0.38), int(h*0.42)), "#CC0000", width=3)

# Wide QRS note
draw_label_box(draw, (int(w*0.05), int(h*0.68)), "WIDE QRS (Pre-excitation via accessory pathway)", "#005599", font=font_small)

img = add_title_bar(img, "7. WPW Syndrome — ECG Findings", "Short PR | Delta waves (slurred QRS start) | Wide QRS")
img.save(f"{OUT}/07_wpw.jpg", quality=92)
print("  WPW done")

# ─────────────────────────────────────────────
# 8. LVH
# ─────────────────────────────────────────────
print("Processing LVH...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6f580ad89d20f81eb217c5c4e170fd5f86a133a18b1cb9a0bb1be1988678f826.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Deep S in V1 (right precordial — left part of precordials)
draw_rect_highlight(draw, [int(w*0.50), int(h*0.50), int(w*0.60), int(h*0.90)], "#FF2200", width=4)
draw_label_box(draw, (int(w*0.50), int(h*0.91)), "Deep S (V1)", "#CC0000", font=font_label)
draw_arrow(draw, (int(w*0.55), int(h*0.48)), (int(w*0.55), int(h*0.55)), "#CC0000", width=3)

# Tall R in V5 (lateral precordial)
draw_rect_highlight(draw, [int(w*0.73), int(h*0.08), int(w*0.82), int(h*0.55)], "#0088FF", width=4)
draw_label_box(draw, (int(w*0.72), int(h*0.04)), "Tall R (V5)", "#0044CC", font=font_label)
draw_arrow(draw, (int(w*0.77), int(h*0.10)), (int(w*0.77), int(h*0.16)), "#0044CC", width=3)

# Formula label
draw_label_box(draw, (int(w*0.30), int(h*0.70)), "S(V1) + R(V5) ≥ 35mm = LVH!", "#005500", font=font_label)
draw_label_box(draw, (int(w*0.30), int(h*0.82)), "Sokolow-Lyon Criteria", "#003300", font=font_small)

img = add_title_bar(img, "8. Left Ventricular Hypertrophy (LVH)", "S(V1) + R(V5/V6) ≥ 35mm = Sokolow-Lyon Criteria positive")
img.save(f"{OUT}/08_lvh.jpg", quality=92)
print("  LVH done")

# ─────────────────────────────────────────────
# 9. Acute Pericarditis
# ─────────────────────────────────────────────
print("Processing Pericarditis...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_cd4008531c1b1a2a99ab6d9b4282dcdcedfcf77c302b6ecbb7f7e01c5c985cf9.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Diffuse saddle ST elevation — highlight multiple leads
# Limb leads area (left portion)
draw_rect_highlight(draw, [int(w*0.03), int(h*0.03), int(w*0.48), int(h*0.60)], "#FF6600", width=4)
draw_label_box(draw, (int(w*0.04), int(h*0.04)), "DIFFUSE SADDLE-SHAPED ST ELEVATION", "#CC4400", font=font_label)

# PR depression arrow in lead II
draw_circle_highlight(draw, (int(w*0.22), int(h*0.52)), 25, "#FF2200", width=4)
draw_label_box(draw, (int(w*0.22), int(h*0.64)), "PR DEPRESSION (Lead II)", "#880000", font=font_label)
draw_arrow(draw, (int(w*0.22), int(h*0.63)), (int(w*0.22), int(h*0.55)), "#880000", width=3)

# Precordial leads
draw_rect_highlight(draw, [int(w*0.50), int(h*0.03), int(w*0.98), int(h*0.60)], "#FF6600", width=3)
draw_label_box(draw, (int(w*0.55), int(h*0.62)), "ST elevation V2-V6 (concave/saddle)", "#884400", font=font_small)

# aVR depression
draw_circle_highlight(draw, (int(w*0.37), int(h*0.35)), 22, "#0088FF", width=4)
draw_label_box(draw, (int(w*0.33), int(h*0.20)), "aVR: ST Depression", "#004499", font=font_small)
draw_arrow(draw, (int(w*0.37), int(h*0.22)), (int(w*0.37), int(h*0.32)), "#004499", width=3)

img = add_title_bar(img, "9. Acute Pericarditis — ECG Findings", "Diffuse saddle ST elevation | PR depression | aVR: ST depression")
img.save(f"{OUT}/09_pericarditis.jpg", quality=92)
print("  Pericarditis done")

# ─────────────────────────────────────────────
# 10. Atrial Flutter (reuse a relevant image — use inferolateral STEMI as placeholder, actually search for flutter)
# Use PE image which showed regular tachycardia, annotate with flutter concept
# Actually annotate the AF image differently for flutter comparison
# Use a clear annotation showing sawtooth concept
# ─────────────────────────────────────────────
# For flutter, let's annotate the fast AF image to show comparison
print("Processing Atrial Flutter (sawtooth diagram)...")
img = download("https://cdn.orris.care/cdss_images/pmc_clinical_VQA_871a12f996b03d3c4d429d8a37d8a72bb639ef845d0ea0fdbb5f84630861acb0.jpg")
draw = ImageDraw.Draw(img)
w, h = img.size

# Highlight the fast rate
draw_rect_highlight(draw, [int(w*0.03), int(h*0.03), int(w*0.97), int(h*0.97)], "#FF8800", width=4)
draw_label_box(draw, (int(w*0.20), int(h*0.08)), "FAST AF (126 bpm) — Compare with Flutter", "#995500", font=font_label)

# Show irregular R-R
rr_positions = [int(w*0.12), int(w*0.23), int(w*0.31), int(w*0.42), int(w*0.51), int(w*0.60), int(w*0.71), int(w*0.80), int(w*0.89)]
for i, rx in enumerate(rr_positions):
    draw.line([(rx, int(h*0.10)), (rx, int(h*0.88))], fill="#00DD00", width=2)

draw_label_box(draw, (int(w*0.03), int(h*0.60)), "IRREGULAR R-R = AF (Flutter is REGULAR at ~150bpm)", "#005500", font=font_small)
draw_label_box(draw, (int(w*0.03), int(h*0.70)), "Flutter: Sawtooth 300/min, 2:1 block → rate ~150", "#004488", font=font_small)
draw_label_box(draw, (int(w*0.03), int(h*0.80)), "Flutter: Look for 'F' waves in II, III, aVF baseline", "#660088", font=font_small)

img = add_title_bar(img, "10. Atrial Flutter vs AF — Key Difference", "Flutter: REGULAR 150bpm + Sawtooth F-waves | AF: IRREGULAR + No P waves")
img.save(f"{OUT}/10_flutter.jpg", quality=92)
print("  Flutter done")

print("\nAll ECG annotations complete!")
print("Files saved in:", OUT)
import os
for f in sorted(os.listdir(OUT)):
    size = os.path.getsize(f"{OUT}/{f}")
    print(f"  {f} — {size//1024} KB")

python3 /tmp/ecg_annotate.py

/tmp/ecg_annotate.py

Error: String not found in file: '    draw_label_box(draw, (int(w*0.05), int(h*0.04)), "IRREGULAR R-R INTERVALS (No fixed pattern)", "#00880000"[:8]+"008800", "#00AA00", "white", font=font_small)
    draw_label_box(draw, (int(w*0.05), int(h*0.04)), "IRREGULAR R-R INTERVALS", "#005500", font=font_small)'