heart block ECG types first degree second degree third degree AV block

ls -la /tmp/workspace/ 2>/dev/null || mkdir -p /tmp/workspace && echo "workspace ready"

mkdir -p /tmp/workspace/heart-block-doc && python3 << 'PYEOF' from docx import Document from docx.shared import Pt, Inches, RGBColor, Cm from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.enum.table import WD_TABLE_ALIGNMENT, WD_ALIGN_VERTICAL from docx.oxml.ns import qn from docx.oxml import OxmlElement import datetime doc = Document() # ── Page margins ────────────────────────────────────────────────────────────── for section in doc.sections: section.top_margin = Cm(2.0) section.bottom_margin = Cm(2.0) section.left_margin = Cm(2.5) section.right_margin = Cm(2.5) # ── Default Normal style ────────────────────────────────────────────────────── normal = doc.styles["Normal"] normal.font.name = "Calibri" normal.font.size = Pt(11) # ── Helper: shade a table cell ──────────────────────────────────────────────── def shade_cell(cell, hex_color): tc = cell._tc tcPr = tc.get_or_add_tcPr() shd = OxmlElement("w:shd") shd.set(qn("w:val"), "clear") shd.set(qn("w:color"), "auto") shd.set(qn("w:fill"), hex_color) tcPr.append(shd) def set_cell_border(cell, **kwargs): """Set borders on a cell. kwargs: top, bottom, left, right = (sz, color, val)""" tc = cell._tc tcPr = tc.get_or_add_tcPr() tcBorders = OxmlElement("w:tcBorders") for edge in ("top","left","bottom","right"): if edge in kwargs: sz, color, val = kwargs[edge] border = OxmlElement(f"w:{edge}") border.set(qn("w:val"), val) border.set(qn("w:sz"), str(sz)) border.set(qn("w:color"), color) tcBorders.append(border) tcPr.append(tcBorders) def add_colored_heading(doc, text, level=1, rgb=(0,51,102)): h = doc.add_heading(text, level=level) h.alignment = WD_ALIGN_PARAGRAPH.LEFT for run in h.runs: run.font.color.rgb = RGBColor(*rgb) return h def add_section_box(doc, title, body_lines, title_bg="1F3864", title_fg=(255,255,255), body_bg="EBF3FB"): """Renders a colored box with a title row and content rows.""" tbl = doc.add_table(rows=1+len(body_lines), cols=1) tbl.style = "Table Grid" tbl.alignment = WD_TABLE_ALIGNMENT.CENTER # title row title_cell = tbl.rows[0].cells[0] shade_cell(title_cell, title_bg) p = title_cell.paragraphs[0] p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run(title) run.bold = True run.font.color.rgb = RGBColor(*title_fg) run.font.size = Pt(12) # body rows for i, line in enumerate(body_lines): c = tbl.rows[i+1].cells[0] shade_cell(c, body_bg) bp = c.paragraphs[0] bp.alignment = WD_ALIGN_PARAGRAPH.LEFT bp.add_run(line).font.size = Pt(10.5) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # COVER HEADER # ══════════════════════════════════════════════════════════════════════════════ p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.CENTER run = p.add_run("CLINICAL SUMMARY") run.bold = True run.font.size = Pt(22) run.font.color.rgb = RGBColor(0, 51, 102) run.font.name = "Calibri" p2 = doc.add_paragraph() p2.alignment = WD_ALIGN_PARAGRAPH.CENTER run2 = p2.add_run("Heart Block: Diagnosis and Treatment") run2.bold = True run2.font.size = Pt(16) run2.font.color.rgb = RGBColor(192, 0, 0) run2.font.name = "Calibri" p3 = doc.add_paragraph() p3.alignment = WD_ALIGN_PARAGRAPH.CENTER meta = p3.add_run(f"Prepared by: Orris Clinical AI | Date: {datetime.date.today().strftime('%B %d, %Y')} | Evidence Based: Braunwald's Heart Disease, Goldman-Cecil Medicine") meta.font.size = Pt(9) meta.font.color.rgb = RGBColor(100, 100, 100) # divider line doc.add_paragraph("─" * 90) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 1 – DEFINITION & OVERVIEW # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "1. Definition and Overview", level=1, rgb=(0,51,102)) p = doc.add_paragraph() p.add_run( "Heart block is a disturbance of impulse conduction along the atrioventricular (AV) " "conduction system that can be permanent or transient depending on the anatomic or " "functional impairment. It is distinct from physiologic interference, which is caused " "by normal refractoriness. The block may occur at the AV node, the His bundle, or the " "bundle branches." ) doc.add_paragraph() # Anatomy box add_section_box(doc, "Cardiac Conduction System - Key Levels", [ " SA Node -> Atria -> AV Node -> Bundle of His -> Bundle Branches (L + R) -> Purkinje Fibers -> Ventricles", " First-degree & Mobitz I blocks: usually at the AV node level (supra-Hisian)", " Mobitz II & complete block: usually infranodal (below His bundle - bundle branches)", ], title_bg="1F3864", body_bg="D6E4F0" ) # ══════════════════════════════════════════════════════════════════════════════ # SECTION 2 – ECG COMPONENTS # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "2. Key ECG Components", level=1, rgb=(0,51,102)) ecg_data = [ ("P Wave", "<120 ms; <2.5 mm", "Atrial depolarization (SA node to AV node)"), ("PR Interval", "120-200 ms (0.12-0.20 s)", "AV nodal conduction + His-Purkinje time"), ("QRS Complex", "<120 ms", "Ventricular depolarization"), ("QT Interval", "350-440 ms (rate-corrected)","Total ventricular electrical activity"), ("T Wave", "Concordant with QRS", "Ventricular repolarization"), ] tbl = doc.add_table(rows=1+len(ecg_data), cols=3) tbl.style = "Table Grid" tbl.alignment = WD_TABLE_ALIGNMENT.CENTER headers = ["Component", "Normal Value", "Represents"] for i, h in enumerate(headers): cell = tbl.rows[0].cells[i] shade_cell(cell, "2E5090") run = cell.paragraphs[0].add_run(h) run.bold = True run.font.color.rgb = RGBColor(255,255,255) run.font.size = Pt(10) row_colors = ["FFFFFF","F0F4FA","FFFFFF","F0F4FA","FFFFFF"] for i, (comp, val, rep) in enumerate(ecg_data): row = tbl.rows[i+1] shade_cell(row.cells[0], row_colors[i]) shade_cell(row.cells[1], row_colors[i]) shade_cell(row.cells[2], row_colors[i]) row.cells[0].paragraphs[0].add_run(comp).font.bold = True row.cells[1].paragraphs[0].add_run(val).font.size = Pt(10) row.cells[2].paragraphs[0].add_run(rep).font.size = Pt(10) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 3 – CLASSIFICATION # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "3. Classification of Heart Blocks", level=1, rgb=(0,51,102)) # 3.1 First degree add_colored_heading(doc, "3.1 First-Degree AV Block", level=2, rgb=(31, 73, 125)) p = doc.add_paragraph() p.add_run("Definition: ").bold = True p.add_run("Every atrial impulse is conducted to the ventricles (1:1 ratio) but with prolonged conduction time. The PR interval exceeds 0.20 seconds in every beat.") p = doc.add_paragraph() p.add_run("Site of Block: ").bold = True p.add_run("Usually the AV node (prolonged A-H interval). When QRS shows a bundle branch block pattern, the delay may be within the His-Purkinje system.") doc.add_paragraph() add_colored_heading(doc, "ECG Features", level=3, rgb=(68,114,196)) ecg_1 = doc.add_paragraph(style="List Bullet") ecg_1.add_run("PR interval > 200 ms in every beat (hallmark finding)").bold = True for item in [ "P:QRS ratio = 1:1 (every P wave followed by a QRS)", "Regular R-R intervals", "QRS complex is usually normal width (<120 ms)", "PR intervals as long as 1.0 second have been documented", ]: bp = doc.add_paragraph(style="List Bullet") bp.add_run(item) doc.add_paragraph() add_colored_heading(doc, "Clinical Features & Management", level=3, rgb=(68,114,196)) p = doc.add_paragraph(style="List Bullet"); p.add_run("Asymptomatic - no haemodynamic compromise") p = doc.add_paragraph(style="List Bullet"); p.add_run("Diminished S1 intensity; long a-to-c wave in jugular venous pulse") p = doc.add_paragraph(style="List Bullet"); p.add_run("No treatment required. Monitor for progression") p = doc.add_paragraph(style="List Bullet"); p.add_run("Can progress to Type I second-degree block with vagal stimulation or with increased atrial rate") doc.add_paragraph() # 3.2 Second degree add_colored_heading(doc, "3.2 Second-Degree AV Block", level=2, rgb=(31,73,125)) p = doc.add_paragraph() p.add_run("Definition: ").bold = True p.add_run("Some P waves are not conducted to the ventricles. There are two distinct subtypes with different mechanisms, sites, prognoses, and treatments.") doc.add_paragraph() # Mobitz I add_colored_heading(doc, "Mobitz Type I (Wenckebach)", level=3, rgb=(68,114,196)) p = doc.add_paragraph() p.add_run("Key Hallmark: ").bold = True p.add_run("Progressive PR interval lengthening until a P wave is dropped, then the cycle resets to the shortest PR.") add_colored_heading(doc, "ECG Features", level=3, rgb=(68,114,196)) for item in [ "Progressively increasing PR interval in successive beats", "Longest PR interval immediately before the dropped beat", "Shortest PR interval immediately after the dropped beat (cycle reset)", "R-R intervals progressively shorten before the pause", "Pause (non-conducted beat) is less than twice the shortest R-R interval", "QRS complex is narrow (<0.12 sec) - block is at AV node", "P:QRS ratio e.g. 4:3, 3:2", ]: bp = doc.add_paragraph(style="List Bullet"); bp.add_run(item) add_colored_heading(doc, "Clinical Context", level=3, rgb=(68,114,196)) for item in [ "Associated with inferior MI (RCA territory - right coronary artery supplies AV node)", "May occur during sleep in well-conditioned athletes (vagal tone)", "Rarely progresses to complete heart block", "Treatment: Observation; atropine if symptomatic bradycardia", ]: bp = doc.add_paragraph(style="List Bullet"); bp.add_run(item) doc.add_paragraph() # Mobitz II add_colored_heading(doc, "Mobitz Type II", level=3, rgb=(68,114,196)) p = doc.add_paragraph() p.add_run("Key Hallmark: ").bold = True p.add_run("P waves drop suddenly WITHOUT any preceding PR interval lengthening.") add_colored_heading(doc, "ECG Features", level=3, rgb=(68,114,196)) for item in [ "Fixed, constant PR interval in all conducted beats (no progressive lengthening)", "Sudden non-conducted P wave without warning or preceding PR change", "QRS complex is usually wide (>0.12 sec) or shows bundle branch block pattern", "Block is infranodal (below the His bundle - bundle branch level)", "May show 2:1, 3:1 or higher conduction ratios", ]: bp = doc.add_paragraph(style="List Bullet"); bp.add_run(item) add_colored_heading(doc, "Clinical Context", level=3, rgb=(68,114,196)) for item in [ "Associated with anterior MI (LAD territory - affects bundle branches)", "High risk of progression to complete (third-degree) AV block", "Requires permanent pacemaker implantation", "Emergency transvenous pacing if haemodynamically unstable", ]: bp = doc.add_paragraph(style="List Bullet"); bp.add_run(item) doc.add_paragraph() # 2:1 special note p = doc.add_paragraph() run = p.add_run("Special Case - 2:1 AV Block: ") run.bold = True run.font.color.rgb = RGBColor(192,0,0) p.add_run( "When every alternate P wave is blocked, it is impossible to distinguish Mobitz I from " "Mobitz II from surface ECG alone. Narrow QRS suggests Type I (nodal); wide QRS/BBB " "suggests Type II (infranodal). His bundle electrogram may be required for definitive classification." ) doc.add_paragraph() # High grade add_colored_heading(doc, "High-Grade (Advanced) AV Block", level=3, rgb=(68,114,196)) p = doc.add_paragraph() p.add_run("Definition: ").bold = True p.add_run("Two or more consecutive P waves are blocked (e.g., 3:1, 4:1 conduction). Implies near-complete failure of AV conduction. Indication for pacing.") doc.add_paragraph() # 3.3 Third degree add_colored_heading(doc, "3.3 Third-Degree (Complete) AV Block", level=2, rgb=(31,73,125)) p = doc.add_paragraph() p.add_run("Definition: ").bold = True p.add_run("No atrial impulses are conducted to the ventricles. Complete AV dissociation - atria and ventricles beat independently, each driven by separate pacemakers.") add_colored_heading(doc, "ECG Features", level=3, rgb=(68,114,196)) for item in [ "P waves and QRS complexes are completely independent (no fixed PR relationship)", "Atrial rate is faster than ventricular rate", "Regular P-P intervals (atria firing from SA node normally)", "Regular R-R intervals (escape pacemaker is regular, but slow)", "P wave may appear to fall before a QRS but does NOT conduct it (coincidental timing - PR keeps varying)", "Narrow QRS (40-60 bpm): junctional escape from His bundle - more stable", "Wide QRS (20-40 bpm): ventricular escape from Purkinje/ventricular myocardium - less stable, more dangerous", ]: bp = doc.add_paragraph(style="List Bullet"); bp.add_run(item) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 4 – COMPARISON TABLE # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "4. Summary Comparison Table", level=1, rgb=(0,51,102)) col_headers = ["Feature", "1st Degree", "2nd Deg Mobitz I", "2nd Deg Mobitz II", "3rd Degree (Complete)"] rows_data = [ ("P:QRS Ratio", "1:1", ">1:1 (intermittent)", ">1:1 (intermittent)", "Independent"), ("PR Interval", ">200 ms fixed","Progressive increase","Fixed / constant", "No relationship"), ("QRS Width", "Narrow", "Narrow (<120 ms)", "Wide / BBB", "Narrow (junctional)\nor Wide (ventricular)"), ("Block Site", "AV node", "AV node", "Infranodal", "Complete AV"), ("Associated MI", "—", "Inferior MI", "Anterior MI", "Either"), ("Progression Risk", "Minimal", "Low", "High", "N/A (already complete)"), ("Treatment", "None", "Observe / atropine", "Pacemaker", "Permanent pacemaker"), ] tbl2 = doc.add_table(rows=1+len(rows_data), cols=5) tbl2.style = "Table Grid" tbl2.alignment = WD_TABLE_ALIGNMENT.CENTER # Set column widths col_widths = [Cm(3.2), Cm(2.8), Cm(3.5), Cm(3.5), Cm(4.0)] for i, w in enumerate(col_widths): for row in tbl2.rows: row.cells[i].width = w for i, h in enumerate(col_headers): cell = tbl2.rows[0].cells[i] shade_cell(cell, "1F3864") run = cell.paragraphs[0].add_run(h) run.bold = True run.font.color.rgb = RGBColor(255,255,255) run.font.size = Pt(9) cell.paragraphs[0].alignment = WD_ALIGN_PARAGRAPH.CENTER alt_row_colors = ["FFFFFF","EEF4FB"] highlight_rows = {5: "FFF2CC", 6: "FFE0E0"} # highlight progression & treatment rows for i, row_vals in enumerate(rows_data): row = tbl2.rows[i+1] bg = highlight_rows.get(i, alt_row_colors[i % 2]) for j, val in enumerate(row_vals): cell = row.cells[j] shade_cell(cell, bg) p = cell.paragraphs[0] p.alignment = WD_ALIGN_PARAGRAPH.CENTER if j > 0 else WD_ALIGN_PARAGRAPH.LEFT run = p.add_run(val) run.font.size = Pt(9) if j == 0: run.bold = True doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 5 – AETIOLOGY # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "5. Aetiology", level=1, rgb=(0,51,102)) causes = { "Ischaemic": [ "Inferior MI - RCA occlusion (AV node ischaemia): tends to cause 1st/2nd degree, usually reversible", "Anterior MI - LAD occlusion (bundle branch ischaemia): tends to cause Mobitz II / complete block, often permanent", ], "Degenerative": [ "Lenegre disease: fibrosis of the His-Purkinje system (primary idiopathic)", "Lev disease: calcification extending from valves / fibrous skeleton into conduction system", ], "Infectious / Inflammatory": [ "Lyme disease (Borrelia burgdorferi) - most common infectious cause in endemic areas", "Rheumatic fever, endocarditis", "Myocarditis (viral, autoimmune)", "Chagas disease (Trypanosoma cruzi) - common cause in South America", "Sarcoidosis", ], "Drugs": [ "Digoxin toxicity", "Beta-blockers", "Calcium channel blockers (non-dihydropyridine: verapamil, diltiazem)", "Amiodarone", "Antiarrhythmics: Class Ia and Ic agents", ], "Congenital": [ "Isolated congenital complete AV block - most common congenital conduction disorder", "Neonatal lupus: maternal anti-Ro/La (SSA/SSB) antibodies crossing placenta", "Associated with congenital heart disease (e.g., L-TGA, AV canal defect)", ], "Metabolic / Electrolyte": [ "Hyperkalaemia", "Hypothyroidism", "Hypomagnesaemia", ], "Iatrogenic": [ "Post-cardiac surgery (valve replacement, VSD repair)", "Transcatheter aortic valve replacement (TAVR/TAVI)", "Catheter ablation", ], } for category, items in causes.items(): p = doc.add_paragraph() run = p.add_run(category + ":") run.bold = True run.font.color.rgb = RGBColor(0, 51, 102) for item in items: bp = doc.add_paragraph(style="List Bullet") bp.add_run(item).font.size = Pt(10.5) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 6 – CLINICAL FEATURES # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "6. Clinical Features", level=1, rgb=(0,51,102)) p = doc.add_paragraph() p.add_run("Symptoms depend on the degree and haemodynamic impact of the block:").italic = True symptoms_table = [ ("First-Degree", "Asymptomatic", "Soft S1; long a-to-c JVP interval"), ("Second-Degree I", "Usually asymptomatic / mild", "Irregular pulse with pauses; variable S1 intensity"), ("Second-Degree II","Palpitations, presyncope", "Irregular pulse; wide pulse pressure"), ("Third-Degree", "Syncope (Stokes-Adams attacks),\nAngina, dyspnoea, heart failure,\nSudden cardiac death", "Bradycardia, hypotension, cannon A waves\nin JVP, variable S1 intensity"), ] tbl3 = doc.add_table(rows=1+len(symptoms_table), cols=3) tbl3.style = "Table Grid" for i, h in enumerate(["Block Type", "Symptoms", "Signs"]): cell = tbl3.rows[0].cells[i] shade_cell(cell, "2E5090") run = cell.paragraphs[0].add_run(h) run.bold = True; run.font.color.rgb = RGBColor(255,255,255); run.font.size = Pt(10) for i, (btype, symptoms, signs) in enumerate(symptoms_table): row = tbl3.rows[i+1] bg = "FFFFFF" if i % 2 == 0 else "EEF4FB" shade_cell(row.cells[0], bg); shade_cell(row.cells[1], bg); shade_cell(row.cells[2], bg) row.cells[0].paragraphs[0].add_run(btype).font.bold = True row.cells[1].paragraphs[0].add_run(symptoms).font.size = Pt(10) row.cells[2].paragraphs[0].add_run(signs).font.size = Pt(10) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 7 – DIAGNOSIS # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "7. Diagnostic Approach", level=1, rgb=(0,51,102)) diag_steps = [ ("12-Lead ECG (First-line)", "Establishes diagnosis in most cases. Assess: PR interval, P:QRS ratio, PR variation, QRS width, " "P-QRS relationship. Rhythm strip in lead II or V1 is most informative."), ("Ambulatory ECG (Holter Monitor)", "For intermittent/paroxysmal blocks. 24-48 hour recording captures transient episodes not seen on " "resting ECG."), ("Exercise Stress Test", "AV block that worsens with exercise suggests infranodal disease (more serious). AV block that " "improves with exercise (increased sympathetic tone) suggests nodal disease."), ("His Bundle Electrogram (Electrophysiology Study)", "Gold standard for localising the site of block. Measures A-H interval (AV node) and H-V interval " "(His-Purkinje). Required when site cannot be determined from surface ECG (e.g., 2:1 block)."), ("Blood Tests", "FBC, U&E (hyperkalaemia), thyroid function, Lyme serology (endemic areas), ANA/anti-Ro/La " "(autoimmune), troponin (acute MI), digoxin level."), ("Echocardiogram", "Assess underlying structural heart disease, LV function, valve pathology, cardiomyopathy."), ("Cardiac MRI / CT", "If sarcoidosis, myocarditis, or infiltrative disease suspected."), ] for step, detail in diag_steps: p = doc.add_paragraph() run = p.add_run(step + ": ") run.bold = True run.font.color.rgb = RGBColor(31, 73, 125) p.add_run(detail).font.size = Pt(10.5) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 8 – TREATMENT # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "8. Treatment", level=1, rgb=(0,51,102)) add_colored_heading(doc, "8.1 Acute Management", level=2, rgb=(31,73,125)) p = doc.add_paragraph() p.add_run("For haemodynamically unstable or symptomatic high-degree block:").italic = True acute = [ ("Atropine 0.5-1 mg IV", "First-line for symptomatic bradycardia in AV nodal blocks (Type I, vagally mediated). " "Repeat up to 3 mg total. NOT effective in infranodal (Mobitz II / complete) block."), ("Transcutaneous Pacing (TCP)", "Emergency bridge while transvenous pacing is arranged. Use in Mobitz II or complete block " "with haemodynamic compromise."), ("Transvenous Temporary Pacing", "Placed via internal jugular or subclavian vein. Definitive bridge to permanent pacemaker. " "Indicated in complete block, Mobitz II, and high-grade block."), ("Isoprenaline (Isoproterenol) infusion", "Sympathomimetic - increases ventricular escape rate. Used as bridge when pacing unavailable. " "Caution in ischaemic heart disease."), ("Treat reversible causes", "Withdraw offending drugs (digoxin, beta-blocker, CCB). Correct electrolyte abnormalities. " "Treat acute MI with reperfusion (PCI/thrombolysis) - may restore conduction."), ] for drug, detail in acute: p = doc.add_paragraph(style="List Bullet") run = p.add_run(drug + ": ") run.bold = True p.add_run(detail).font.size = Pt(10.5) doc.add_paragraph() add_colored_heading(doc, "8.2 Permanent Pacemaker Implantation", level=2, rgb=(31,73,125)) p = doc.add_paragraph() p.add_run("Indications (ACC/AHA Class I - permanent pacing is indicated):").bold = True ppm_indications = [ "Complete (third-degree) AV block - symptomatic or asymptomatic with ventricular rate <40 bpm or pauses >3 seconds", "Second-degree Mobitz Type II with wide QRS (infranodal block)", "Symptomatic second-degree AV block of any type", "High-grade AV block (>2:1 with symptoms)", "Chronic bifascicular or trifascicular block with intermittent complete heart block", "Post-TAVI complete AV block persisting >24-48 hours", "Congenital complete AV block with symptoms, wide complex escape, or rate <50 bpm", ] for item in ppm_indications: bp = doc.add_paragraph(style="List Bullet"); bp.add_run(item).font.size = Pt(10.5) doc.add_paragraph() p = doc.add_run if False else doc.add_paragraph() p.add_run("Pacemaker Mode Selection:").bold = True mode_table = [ ("DDD(R)", "Dual chamber pacing + sensing + triggered/inhibited response", "Most physiological - preferred for AV block"), ("VVI(R)", "Ventricular pacing + sensing + inhibited response", "For permanent AF with complete AV block"), ("AAI(R)", "Atrial pacing only", "Sinus node dysfunction without AV block only"), ("His-bundle / LBBP pacing", "Physiological pacing of conduction system", "Emerging - preserves normal LV activation, reduces pacing-induced CMP"), ] tbl4 = doc.add_table(rows=1+len(mode_table), cols=3) tbl4.style = "Table Grid" for i, h in enumerate(["Mode", "Description", "Clinical Use"]): cell = tbl4.rows[0].cells[i] shade_cell(cell, "2E5090") run = cell.paragraphs[0].add_run(h) run.bold = True; run.font.color.rgb = RGBColor(255,255,255); run.font.size = Pt(10) for i, (mode, desc, use) in enumerate(mode_table): row = tbl4.rows[i+1] bg = "FFFFFF" if i % 2 == 0 else "EEF4FB" for j, val in enumerate([mode, desc, use]): cell = row.cells[j] shade_cell(cell, bg) run = cell.paragraphs[0].add_run(val) run.font.size = Pt(10) if j == 0: run.bold = True doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 9 – SPECIAL POPULATIONS # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "9. Special Populations", level=1, rgb=(0,51,102)) specials = [ ("Congenital AV Block (Neonates/Children)", "Maternal anti-Ro/La antibodies cause most cases in utero/neonatal period. " "Mortality highest in the neonatal period. Heart rate <50 bpm at rest correlates with syncope risk. " "Pacemaker indicated for symptomatic children or those with slow escape rates."), ("Acute MI", "Inferior MI: AV block from ischaemia of AV node - usually reversible with reperfusion. " "Anterior MI: block from septal ischaemia affecting bundle branches - often permanent, higher mortality. " "Temporary pacing is the bridge; assess for recovery of conduction at 5-7 days."), ("Lyme Disease", "AV block occurs in ~1% of Lyme carditis. Usually reversible with antibiotic treatment (doxycycline/amoxicillin). " "Temporary pacing if PR >300 ms, high-degree block, or haemodynamically unstable. " "Permanent pacing only if block persists after antibiotics."), ("Post-TAVR", "Complete AV block occurs in 15-30% of TAVR cases, particularly with self-expanding prostheses " "and pre-existing RBBB. Requires temporary pacing post-procedure; permanent pacemaker if persistent."), ] for title, detail in specials: p = doc.add_paragraph() run = p.add_run(title + ": ") run.bold = True run.font.color.rgb = RGBColor(0, 51, 102) p.add_run(detail).font.size = Pt(10.5) doc.add_paragraph() # ══════════════════════════════════════════════════════════════════════════════ # SECTION 10 – QUICK REFERENCE CLINICAL DECISION BOX # ══════════════════════════════════════════════════════════════════════════════ add_colored_heading(doc, "10. Clinical Decision Quick Reference", level=1, rgb=(0,51,102)) add_section_box(doc, "KEY CLINICAL RULE: Narrow vs. Wide QRS in AV Block", [ " NARROW QRS in AV block -> Block is at AV node level -> Lower risk, atropine may work, may be reversible", " WIDE QRS in AV block -> Block is infranodal (bundle branches) -> Higher risk, atropine INEFFECTIVE, pacemaker needed", " Exercise worsens block -> Infranodal disease (serious) | Exercise improves block -> Nodal disease (benign)", ], title_bg="C00000", title_fg=(255,255,255), body_bg="FFF2CC" ) add_section_box(doc, "ATROPINE: When to Use vs. Avoid", [ " USE atropine: First-degree AV block (if symptomatic), Mobitz Type I (Wenckebach), Inferior MI with AV block", " AVOID atropine: Mobitz Type II, Complete AV block with wide QRS, Post-cardiac transplant", " Dose: 0.5 mg IV; repeat q3-5 min to maximum 3 mg total", ], title_bg="1F3864", title_fg=(255,255,255), body_bg="EBF3FB" ) # ══════════════════════════════════════════════════════════════════════════════ # FOOTER / REFERENCES # ══════════════════════════════════════════════════════════════════════════════ doc.add_paragraph("─" * 90) p = doc.add_paragraph() p.alignment = WD_ALIGN_PARAGRAPH.LEFT run = p.add_run("References & Sources") run.bold = True run.font.color.rgb = RGBColor(0,51,102) run.font.size = Pt(11) refs = [ "1. Zipes DP, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 12th Ed. Elsevier, 2022.", "2. Goldman L, Schafer AI. Goldman-Cecil Medicine, 27th Ed. Elsevier, 2022.", "3. Tierney LM, et al. Symptom to Diagnosis: An Evidence-Based Guide, 4th Ed. McGraw-Hill, 2020.", "4. Epstein AE, et al. ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. J Am Coll Cardiol. 2013.", "5. Brignole M, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021.", ] for ref in refs: p = doc.add_paragraph() p.add_run(ref).font.size = Pt(9) p_footer = doc.add_paragraph() p_footer.alignment = WD_ALIGN_PARAGRAPH.CENTER run_f = p_footer.add_run("This document is intended for educational purposes only. Always apply clinical judgement and refer to current institutional guidelines.") run_f.font.size = Pt(8) run_f.font.italic = True run_f.font.color.rgb = RGBColor(128,128,128) # ── Save ────────────────────────────────────────────────────────────────────── output_path = "/tmp/workspace/heart-block-doc/Heart_Block_Clinical_Summary.docx" doc.save(output_path) print(f"SUCCESS: {output_path}") PYEOF

python3 -c " from docx import Document doc = Document('/tmp/workspace/heart-block-doc/Heart_Block_Clinical_Summary.docx') print(f'Paragraphs: {len(doc.paragraphs)}') print(f'Tables: {len(doc.tables)}') for i, tbl in enumerate(doc.tables): print(f' Table {i+1}: {len(tbl.rows)} rows x {len(tbl.columns)} cols') # print first few headings for p in doc.paragraphs[:30]: if p.style.name.startswith('Heading'): print(f' [{p.style.name}] {p.text}') import os size = os.path.getsize('/tmp/workspace/heart-block-doc/Heart_Block_Clinical_Summary.docx') print(f'File size: {size:,} bytes') "