Electrocardiogram (ECG) - A Detailed Guide

const pptxgen = require("pptxgenjs");
const fs = require("fs");

// Load pre-fetched images
const img0 = fs.readFileSync("/home/daytona/workspace/ecg-presentation/img0.b64", "utf8"); // conduction system
const img1 = fs.readFileSync("/home/daytona/workspace/ecg-presentation/img1.b64", "utf8"); // ECG waveform labeled
const img2 = fs.readFileSync("/home/daytona/workspace/ecg-presentation/img2.b64", "utf8"); // precordial leads
const img3 = fs.readFileSync("/home/daytona/workspace/ecg-presentation/img3.b64", "utf8"); // Einthoven's triangle
const img4 = fs.readFileSync("/home/daytona/workspace/ecg-presentation/img4.b64", "utf8"); // normal 12-lead ECG

// ─── Color Palette ───────────────────────────────────────────────
const DARK_BG    = "0D1B2A";   // deep navy  (dominant)
const MID_BG     = "1B2A3B";   // mid navy
const CARD_BG    = "162230";   // card background
const ACCENT     = "E63946";   // bold red-crimson (ECG line color)
const ACCENT2    = "26C6DA";   // teal (labels, highlights)
const GOLD       = "FFB703";   // amber (key values)
const WHITE      = "FFFFFF";
const LIGHT_GRAY = "B0C4D8";
const MUTED      = "6E8BA3";

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author  = "Orris Medical";
pres.title   = "ECG Interpretation & Common Pathologic Patterns";

// ─────────────────────────────────────────────────────────────────
// Helper: dark slide background
function darkBg(slide) {
  slide.background = { color: DARK_BG };
}

// Helper: accent bar at top
function topBar(slide, color = ACCENT) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.08, fill: { color }, line: { type: "none" }
  });
}

// Helper: section heading
function sectionHead(slide, title, subtitle = "") {
  slide.addText(title, {
    x: 0.45, y: 0.18, w: 9.1, h: 0.55,
    fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri",
    margin: 0
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.45, y: 0.72, w: 9.1, h: 0.3,
      fontSize: 11, color: ACCENT2, fontFace: "Calibri", italic: true, margin: 0
    });
  }
}

// Helper: divider line
function divider(slide, y = 0.65, color = ACCENT, opacity = 0.6) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0.45, y, w: 9.1, h: 0.025,
    fill: { color, transparency: Math.round((1 - opacity) * 100) },
    line: { type: "none" }
  });
}

// Helper: card (rounded rect)
function card(slide, x, y, w, h, fillColor = CARD_BG) {
  slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x, y, w, h,
    fill: { color: fillColor },
    line: { color: ACCENT2, pt: 0.5, transparency: 60 },
    rectRadius: 0.12,
    shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.25 }
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 1: Title
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);

  // ECG-line decorative band at top
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.55, fill: { color: ACCENT }, line: { type: "none" }
  });
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0.55, w: 10, h: 0.06, fill: { color: GOLD }, line: { type: "none" }
  });

  // Title
  slide.addText("ECG Interpretation", {
    x: 0.4, y: 1.0, w: 9.2, h: 0.9,
    fontSize: 46, bold: true, color: WHITE, fontFace: "Calibri",
    align: "center", charSpacing: 2
  });
  slide.addText("& Common Pathologic Patterns", {
    x: 0.4, y: 1.85, w: 9.2, h: 0.6,
    fontSize: 26, color: ACCENT2, fontFace: "Calibri",
    align: "center", italic: true
  });

  // Subtitle bar
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 3.0, y: 2.6, w: 4.0, h: 0.04, fill: { color: GOLD }, line: { type: "none" }
  });

  // Decorative ECG waveform image (labeled waveform)
  slide.addImage({ data: img1, x: 1.2, y: 3.0, w: 7.6, h: 1.9, transparency: 18 });

  // Footer
  slide.addText("Goldman-Cecil Medicine  ·  Guyton & Hall Physiology", {
    x: 0, y: 5.2, w: 10, h: 0.35,
    fontSize: 9, color: MUTED, align: "center", fontFace: "Calibri", italic: true
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 2: Table of Contents
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, GOLD);
  sectionHead(slide, "Overview", "What this presentation covers");
  divider(slide, 0.65, GOLD);

  const topics = [
    ["01", "The Cardiac Conduction System",    "Anatomy of electrical activation"],
    ["02", "ECG Waveforms & Intervals",         "P, QRS, T, U · PR, QT, QRS durations"],
    ["03", "The 12-Lead System",                "Limb leads, augmented leads, precordial leads"],
    ["04", "Heart Rate & Axis",                 "Rate calculation · frontal plane axis"],
    ["05", "Conduction Abnormalities",          "Bundle branch blocks · fascicular blocks · AV blocks"],
    ["06", "Ischemia & Infarction",             "ST changes · Q waves · territory recognition"],
    ["07", "Hypertrophy & Enlargement",         "LVH · RVH · atrial enlargement criteria"],
    ["08", "Electrolyte & Drug Effects",        "Hypo/hyperkalaemia · hypercalcaemia · QTc drugs"],
  ];

  const colX = [0.4, 4.85];
  topics.forEach((t, i) => {
    const row = i % 4;
    const col = Math.floor(i / 4);
    const x = colX[col];
    const y = 0.9 + row * 1.12;

    card(slide, x, y, 4.22, 0.96);
    slide.addText(t[0], {
      x: x + 0.12, y: y + 0.08, w: 0.48, h: 0.36,
      fontSize: 14, bold: true, color: ACCENT, fontFace: "Calibri", align: "center"
    });
    slide.addText(t[1], {
      x: x + 0.62, y: y + 0.06, w: 3.5, h: 0.36,
      fontSize: 11.5, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
    });
    slide.addText(t[2], {
      x: x + 0.62, y: y + 0.44, w: 3.5, h: 0.3,
      fontSize: 9.5, color: LIGHT_GRAY, fontFace: "Calibri", italic: true, margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 3: Cardiac Conduction System
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT);
  sectionHead(slide, "The Cardiac Conduction System", "Normal sequence of electrical activation");
  divider(slide);

  // Image: conduction anatomy
  card(slide, 0.4, 0.85, 4.4, 4.4, "0A1520");
  slide.addImage({ data: img0, x: 0.55, y: 0.95, w: 4.1, h: 4.15 });

  // Steps
  const steps = [
    { num: "1", label: "SA Node",       desc: "Right atrium near SVC. Dominant pacemaker (60-100 bpm). Not visible on surface ECG." },
    { num: "2", label: "Atria",         desc: "Wavefront spreads R→L via Bachmann bundle. Generates P wave." },
    { num: "3", label: "AV Node",       desc: "Only bridge between atria & ventricles. Physiologic delay allows ventricular filling." },
    { num: "4", label: "Bundle of His", desc: "Exits AV node into fast-conducting tissue at the ventricular septum." },
    { num: "5", label: "Bundle Branches", desc: "Right bundle branch + Left bundle branch (anterior & posterior fascicles)." },
    { num: "6", label: "Purkinje Fibers", desc: "Rapid subendocardial distribution → ventricular depolarization → QRS complex." },
  ];

  steps.forEach((s, i) => {
    const y = 0.87 + i * 0.74;
    slide.addShape(pres.shapes.ELLIPSE, {
      x: 5.0, y: y + 0.04, w: 0.32, h: 0.32,
      fill: { color: ACCENT }, line: { type: "none" }
    });
    slide.addText(s.num, {
      x: 5.0, y: y + 0.04, w: 0.32, h: 0.32,
      fontSize: 9, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0
    });
    slide.addText(s.label, {
      x: 5.38, y: y + 0.03, w: 4.2, h: 0.22,
      fontSize: 11, bold: true, color: ACCENT2, fontFace: "Calibri", margin: 0
    });
    slide.addText(s.desc, {
      x: 5.38, y: y + 0.26, w: 4.2, h: 0.38,
      fontSize: 9, color: LIGHT_GRAY, fontFace: "Calibri", margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 4: ECG Waveforms & Intervals
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT2);
  sectionHead(slide, "ECG Waveforms & Intervals", "Every deflection has a physiological meaning");
  divider(slide, 0.65, ACCENT2);

  // Large waveform image
  card(slide, 0.4, 0.82, 4.2, 4.5, "080F18");
  slide.addImage({ data: img1, x: 0.5, y: 0.9, w: 4.0, h: 4.3 });

  // Wave table
  const waves = [
    { wave: "P Wave",        color: ACCENT2, normal: "< 120ms, < 0.3mV",          meaning: "Atrial depolarization" },
    { wave: "PR Interval",   color: GOLD,    normal: "120–200 ms",                 meaning: "AV conduction time" },
    { wave: "QRS Complex",   color: ACCENT,  normal: "< 110 ms; 1.0–1.5 mV",      meaning: "Ventricular depolarization" },
    { wave: "ST Segment",    color: WHITE,   normal: "Isoelectric (±0.5mm)",        meaning: "Plateau phase (no net current)" },
    { wave: "T Wave",        color: GOLD,    normal: "0.2–0.3 mV; concordant",     meaning: "Ventricular repolarization" },
    { wave: "QT Interval",   color: ACCENT2, normal: "QTc < 440ms ♂ / 460ms ♀",   meaning: "Total ventricular recovery" },
    { wave: "U Wave",        color: MUTED,   normal: "Small, positive",             meaning: "Purkinje / M-cell repolarization" },
  ];

  waves.forEach((w, i) => {
    const y = 0.85 + i * 0.675;
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    slide.addText(w.wave, {
      x: 4.96, y: y + 0.05, w: 1.65, h: 0.26,
      fontSize: 10.5, bold: true, color: w.color, fontFace: "Calibri", margin: 0
    });
    slide.addText(w.normal, {
      x: 4.96, y: y + 0.32, w: 1.65, h: 0.22,
      fontSize: 8.5, color: LIGHT_GRAY, fontFace: "Calibri", margin: 0, italic: true
    });
    slide.addText(w.meaning, {
      x: 6.65, y: y + 0.15, w: 2.78, h: 0.3,
      fontSize: 9.5, color: WHITE, fontFace: "Calibri", margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 5: The 12-Lead System
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, GOLD);
  sectionHead(slide, "The 12-Lead ECG System", "12 views of the heart's electrical activity");
  divider(slide, 0.65, GOLD);

  // Einthoven image
  card(slide, 0.4, 0.85, 3.2, 2.35, "0A1520");
  slide.addImage({ data: img3, x: 0.5, y: 0.88, w: 3.0, h: 2.28 });

  // Precordial image
  card(slide, 0.4, 3.3, 3.2, 2.0, "0A1520");
  slide.addImage({ data: img2, x: 0.5, y: 3.38, w: 3.0, h: 1.85 });

  // Lead groups
  const groups = [
    {
      title: "Bipolar Limb Leads",
      color: ACCENT,
      items: [
        "Lead I   — LA(+) vs RA(−)  →  lateral wall",
        "Lead II  — LL(+) vs RA(−)  →  inferior wall",
        "Lead III — LL(+) vs LA(−)  →  inferior wall",
        "Einthoven's law: I + III = II",
      ]
    },
    {
      title: "Augmented Limb Leads",
      color: ACCENT2,
      items: [
        "aVR — right shoulder view (inverted in normal)",
        "aVL — left shoulder view (lateral)",
        "aVF — inferior view",
        "Normal: upright P & QRS in I, II, III, aVF",
      ]
    },
    {
      title: "Precordial (Chest) Leads  V1–V6",
      color: GOLD,
      items: [
        "V1/V2: right side — rS pattern (negative QRS)",
        "V3/V4: transition zone (R = S at V3 or V4)",
        "V5/V6: left side — tall R wave (positive QRS)",
        "R wave progression: V1→V5 R grows, S shrinks",
      ]
    },
  ];

  groups.forEach((g, i) => {
    const x = 3.82;
    const y = 0.83 + i * 1.55;
    card(slide, x, y, 5.75, 1.42, CARD_BG);
    slide.addShape(pres.shapes.RECTANGLE, {
      x, y, w: 0.12, h: 1.42, fill: { color: g.color }, line: { type: "none" }
    });
    slide.addText(g.title, {
      x: x + 0.2, y: y + 0.06, w: 5.4, h: 0.28,
      fontSize: 11, bold: true, color: g.color, fontFace: "Calibri", margin: 0
    });
    const bullets = g.items.map((t, j) => ({
      text: t, options: { bullet: { code: "2022" }, color: j === 3 ? GOLD : LIGHT_GRAY, fontSize: 9, breakLine: j < g.items.length - 1 }
    }));
    slide.addText(bullets, {
      x: x + 0.22, y: y + 0.36, w: 5.4, h: 0.98,
      fontFace: "Calibri", margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 6: Heart Rate & Axis
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT);
  sectionHead(slide, "Heart Rate & Electrical Axis", "Two fundamental parameters in every ECG read");
  divider(slide);

  // Heart rate card
  card(slide, 0.4, 0.85, 4.5, 2.2, CARD_BG);
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0.4, y: 0.85, w: 0.12, h: 2.2, fill: { color: ACCENT }, line: { type: "none" }
  });
  slide.addText("Heart Rate Calculation", {
    x: 0.62, y: 0.9, w: 4.1, h: 0.32,
    fontSize: 13, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0
  });
  slide.addText([
    { text: "Regular rhythm:", options: { bold: true, color: WHITE, fontSize: 10 } },
    { text: "  300 ÷ (large boxes between R-R peaks)", options: { color: LIGHT_GRAY, fontSize: 10 } },
    { text: "\n   or  1500 ÷ (small boxes between R-R peaks)", options: { color: LIGHT_GRAY, fontSize: 10, italic: true } },
  ], { x: 0.62, y: 1.28, w: 4.1, h: 0.45, fontFace: "Calibri", margin: 0 });

  slide.addText([
    { text: "Irregular rhythm:", options: { bold: true, color: WHITE, fontSize: 10 } },
    { text: "  Count QRS in 10 sec strip × 6", options: { color: LIGHT_GRAY, fontSize: 10 } },
  ], { x: 0.62, y: 1.8, w: 4.1, h: 0.3, fontFace: "Calibri", margin: 0 });

  const rateValues = [
    { label: "Bradycardia",    val: "< 60",   col: ACCENT2 },
    { label: "Normal",         val: "60-100", col: GOLD },
    { label: "Tachycardia",    val: "> 100",  col: ACCENT },
  ];
  rateValues.forEach((r, i) => {
    card(slide, 0.62 + i * 1.46, 2.26, 1.36, 0.65, MID_BG);
    slide.addText(r.val + " bpm", { x: 0.62 + i * 1.46, y: 2.29, w: 1.36, h: 0.28, fontSize: 12, bold: true, color: r.col, align: "center", fontFace: "Calibri", margin: 0 });
    slide.addText(r.label,        { x: 0.62 + i * 1.46, y: 2.56, w: 1.36, h: 0.22, fontSize: 8.5, color: MUTED, align: "center", fontFace: "Calibri", margin: 0 });
  });

  // Axis card
  card(slide, 0.4, 3.22, 4.5, 2.05, CARD_BG);
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0.4, y: 3.22, w: 0.12, h: 2.05, fill: { color: GOLD }, line: { type: "none" }
  });
  slide.addText("QRS Axis (Frontal Plane)", {
    x: 0.62, y: 3.26, w: 4.1, h: 0.3,
    fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", margin: 0
  });
  const axes = [
    { range: "−30° to +90°",   label: "Normal axis",              color: GOLD },
    { range: "−30° to −90°",   label: "Left axis deviation (LAD)", color: ACCENT2 },
    { range: "+90° to +180°",  label: "Right axis deviation (RAD)", color: ACCENT },
    { range: "±180° / −90°",   label: "Extreme (NW) axis",         color: LIGHT_GRAY },
  ];
  axes.forEach((a, i) => {
    const y = 3.62 + i * 0.38;
    slide.addText(a.range, { x: 0.62, y, w: 1.6, h: 0.3, fontSize: 9.5, bold: true, color: a.color, fontFace: "Calibri", margin: 0 });
    slide.addText(a.label, { x: 2.25, y, w: 2.5, h: 0.3, fontSize: 9.5, color: WHITE, fontFace: "Calibri", margin: 0 });
  });

  // Right side: 12-lead normal ECG image
  card(slide, 5.15, 0.85, 4.45, 4.45, "060D14");
  slide.addImage({ data: img4, x: 5.22, y: 0.9, w: 4.3, h: 4.35 });
  slide.addText("Normal 12-Lead ECG", {
    x: 5.15, y: 5.3, w: 4.45, h: 0.2,
    fontSize: 8, color: MUTED, align: "center", fontFace: "Calibri", italic: true
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 7: Conduction Abnormalities
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT2);
  sectionHead(slide, "Conduction Abnormalities", "Bundle branch blocks · fascicular blocks · AV blocks");
  divider(slide, 0.65, ACCENT2);

  const blocks = [
    {
      title: "LBBB — Left Bundle Branch Block",
      color: ACCENT,
      criteria: [
        "QRS ≥ 120 msec (broad, ≥ 3 small boxes)",
        "Broad notched R ('M shape') in I, V5, V6",
        "Deep S or QS in V1 — no r wave",
        "No septal q waves in lateral leads",
        "Discordant ST-T changes (opposite to QRS)",
        "Isolated new LBBB → rule out STEMI (Sgarbossa criteria)",
      ]
    },
    {
      title: "RBBB — Right Bundle Branch Block",
      color: ACCENT2,
      criteria: [
        "QRS ≥ 120 msec",
        "RSR' ('rabbit ears') pattern in V1/V2",
        "Wide, slurred S wave in I, V5, V6",
        "ST depression & T-wave inversion in V1-V3",
        "Incomplete RBBB: same morphology, QRS 100-119 ms",
        "RBBB ± LAD → bifascicular block (high-risk)",
      ]
    },
    {
      title: "AV Blocks",
      color: GOLD,
      criteria: [
        "1st degree: PR > 200 ms, every P conducts — benign",
        "2nd Mobitz I (Wenckebach): Progressive PR ↑ then dropped beat",
        "2nd Mobitz II: Fixed PR then sudden non-conducted P — dangerous",
        "3rd degree (complete): P waves & QRS independent — no relationship",
        "3rd degree: narrow escape = junctional (40-60); wide = ventricular (<40)",
        "Mobitz II & 3rd degree → urgent pacemaker evaluation",
      ]
    },
  ];

  blocks.forEach((b, i) => {
    const y = 0.85 + i * 1.58;
    card(slide, 0.4, y, 9.2, 1.44, CARD_BG);
    slide.addShape(pres.shapes.RECTANGLE, {
      x: 0.4, y, w: 0.14, h: 1.44, fill: { color: b.color }, line: { type: "none" }
    });
    slide.addText(b.title, {
      x: 0.65, y: y + 0.07, w: 8.8, h: 0.28,
      fontSize: 12, bold: true, color: b.color, fontFace: "Calibri", margin: 0
    });
    const leftItems = b.criteria.slice(0, 3);
    const rightItems = b.criteria.slice(3);
    const makeBullets = (arr) => arr.map((t, j) => ({
      text: t, options: { bullet: { code: "25B8" }, color: LIGHT_GRAY, fontSize: 9.5, breakLine: j < arr.length - 1 }
    }));
    slide.addText(makeBullets(leftItems),  { x: 0.65, y: y + 0.4, w: 4.35, h: 0.92, fontFace: "Calibri", margin: 0 });
    slide.addText(makeBullets(rightItems), { x: 5.1,  y: y + 0.4, w: 4.4,  h: 0.92, fontFace: "Calibri", margin: 0 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 8: Ischemia & Infarction
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT);
  sectionHead(slide, "Ischemia & Myocardial Infarction", "ST changes, Q waves, and territory recognition");
  divider(slide);

  // ST changes table
  const stChanges = [
    { title: "STEMI (Acute MI)", color: ACCENT, bg: "1A0A0A",
      points: [
        "ST elevation ≥ 1mm (limb leads) or ≥ 2mm (chest leads)",
        "Convex ('tombstone') or flat ST elevation in ≥ 2 contiguous leads",
        "Reciprocal ST depression in opposite leads (supports diagnosis)",
        "Early: hyperacute tall T waves (first minutes)",
        "Evolves to: Q waves + T inversion + ST returns to baseline",
      ]
    },
    { title: "NSTEMI / Unstable Angina", color: GOLD, bg: "1A1500",
      points: [
        "Horizontal or downsloping ST depression ≥ 0.5mm",
        "T-wave inversion (symmetric, deep) in ischemic territory",
        "No pathological Q waves (no transmural necrosis)",
        "Differentiate NSTEMI from UAP by troponin elevation",
        "Posterior MI: ST depression V1-V3 + tall R in V1 (mirror image)",
      ]
    },
  ];

  stChanges.forEach((s, i) => {
    const y = 0.85 + i * 2.1;
    card(slide, 0.4, y, 5.5, 1.92, s.bg);
    slide.addShape(pres.shapes.RECTANGLE, { x: 0.4, y, w: 0.14, h: 1.92, fill: { color: s.color }, line: { type: "none" } });
    slide.addText(s.title, { x: 0.64, y: y + 0.07, w: 5.1, h: 0.3, fontSize: 12, bold: true, color: s.color, fontFace: "Calibri", margin: 0 });
    const bullets = s.points.map((t, j) => ({ text: t, options: { bullet: { code: "2022" }, color: LIGHT_GRAY, fontSize: 9, breakLine: j < s.points.length - 1 } }));
    slide.addText(bullets, { x: 0.64, y: y + 0.42, w: 5.1, h: 1.38, fontFace: "Calibri", margin: 0 });
  });

  // Territory table
  card(slide, 6.1, 0.85, 3.5, 4.2, CARD_BG);
  slide.addText("Territory Localization", {
    x: 6.22, y: 0.91, w: 3.26, h: 0.3,
    fontSize: 11, bold: true, color: ACCENT2, fontFace: "Calibri", margin: 0
  });
  const territories = [
    { leads: "II, III, aVF",     artery: "RCA",  wall: "Inferior" },
    { leads: "V1–V4",            artery: "LAD",  wall: "Anterior" },
    { leads: "V1–V2",            artery: "LAD/Sep", wall: "Septal" },
    { leads: "I, aVL, V5–V6",   artery: "LCx",  wall: "Lateral" },
    { leads: "V1–V4 + I,aVL",   artery: "LAD",  wall: "Anterolateral" },
    { leads: "V1–V3 mirror",     artery: "LCx",  wall: "Posterior" },
    { leads: "V3R–V4R",          artery: "RCA",  wall: "Right Ventricle" },
  ];

  const tableRows = [
    [
      { text: "Leads",  options: { bold: true, fill: { color: "2A1515" }, color: ACCENT,  fontSize: 9 } },
      { text: "Artery", options: { bold: true, fill: { color: "2A1515" }, color: ACCENT,  fontSize: 9 } },
      { text: "Wall",   options: { bold: true, fill: { color: "2A1515" }, color: ACCENT,  fontSize: 9 } },
    ],
    ...territories.map(t => [
      { text: t.leads,  options: { color: ACCENT2,    fontSize: 8.5, fill: { color: CARD_BG } } },
      { text: t.artery, options: { color: GOLD,       fontSize: 8.5, fill: { color: CARD_BG } } },
      { text: t.wall,   options: { color: LIGHT_GRAY, fontSize: 8.5, fill: { color: CARD_BG } } },
    ])
  ];
  slide.addTable(tableRows, {
    x: 6.22, y: 1.26, w: 3.26, h: 3.65,
    border: { pt: 0.5, color: "2A3A4A" },
    rowH: 0.38,
    colW: [1.35, 0.82, 1.09],
    fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 9: Hypertrophy & Enlargement
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, GOLD);
  sectionHead(slide, "Hypertrophy & Chamber Enlargement", "Voltage and morphology changes from increased wall stress");
  divider(slide, 0.65, GOLD);

  const conditions = [
    {
      title: "Left Ventricular Hypertrophy (LVH)",
      color: ACCENT,
      criteria: [
        "Sokolov-Lyon: S(V1) + R(V5 or V6) ≥ 35mm",
        "Cornell: R(aVL) + S(V3) ≥ 28mm (♂) / ≥ 20mm (♀)",
        "R in aVL ≥ 11mm alone",
        "ST depression + T inversion in V5-V6, I, aVL (strain pattern)",
        "Left axis deviation common",
        "Cause: hypertension, aortic stenosis, HCM",
      ]
    },
    {
      title: "Right Ventricular Hypertrophy (RVH)",
      color: ACCENT2,
      criteria: [
        "Dominant R wave in V1 (R > S in V1)",
        "R/S ratio > 1 in V1 with R/S ratio < 1 in V6",
        "Right axis deviation (> +90°)",
        "ST depression + T inversion in V1-V3 (right strain)",
        "Cause: pulmonary HTN, pulmonary stenosis, cor pulmonale",
        "P pulmonale in II (tall, peaked P > 2.5mm) suggests RAE",
      ]
    },
    {
      title: "Atrial Enlargement",
      color: GOLD,
      criteria: [
        "LAE (P mitrale): P wave > 120ms; bifid (notched) P in II; biphasic P in V1 with deep negative terminal",
        "RAE (P pulmonale): P wave ≥ 2.5mm tall in II, III, or aVF; peaked (not broad)",
        "Biatrial: features of both LAE + RAE simultaneously",
        "Causes of LAE: mitral stenosis, LV failure, hypertension",
        "Causes of RAE: COPD, pulmonary hypertension, tricuspid disease",
        "Atrial enlargement increases AF risk",
      ]
    },
  ];

  conditions.forEach((c, i) => {
    const y = 0.85 + i * 1.58;
    card(slide, 0.4, y, 9.2, 1.44, CARD_BG);
    slide.addShape(pres.shapes.RECTANGLE, { x: 0.4, y, w: 0.14, h: 1.44, fill: { color: c.color }, line: { type: "none" } });
    slide.addText(c.title, { x: 0.64, y: y + 0.07, w: 8.8, h: 0.28, fontSize: 12, bold: true, color: c.color, fontFace: "Calibri", margin: 0 });
    const left  = c.criteria.slice(0, 3).map((t, j) => ({ text: t, options: { bullet: { code: "25B8" }, color: LIGHT_GRAY, fontSize: 9.5, breakLine: j < 2 } }));
    const right = c.criteria.slice(3).map((t, j) => ({ text: t, options: { bullet: { code: "25B8" }, color: LIGHT_GRAY, fontSize: 9.5, breakLine: j < 2 } }));
    slide.addText(left,  { x: 0.64, y: y + 0.4, w: 4.35, h: 0.92, fontFace: "Calibri", margin: 0 });
    slide.addText(right, { x: 5.1,  y: y + 0.4, w: 4.4,  h: 0.92, fontFace: "Calibri", margin: 0 });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 10: Electrolyte & Drug Effects
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT2);
  sectionHead(slide, "Electrolyte & Drug Effects on the ECG", "Recognizing systemic disturbances from the trace");
  divider(slide, 0.65, ACCENT2);

  const effects = [
    { condition: "Hypokalaemia (K⁺ ↓)", color: ACCENT2, changes: ["Prominent U waves (after T)", "Flat or inverted T waves", "ST depression", "Prolonged QU interval (appears as long QT)", "Risk: polymorphic VT (Torsades)"] },
    { condition: "Hyperkalaemia (K⁺ ↑)", color: ACCENT, changes: ["Peaked, tall, narrow (tent-like) T waves — earliest sign", "Widened QRS → sine wave pattern (severe)", "Flattened / absent P waves", "PR prolongation", "Risk: VF / asystole"] },
    { condition: "Hypocalcaemia (Ca²⁺ ↓)", color: GOLD, changes: ["Prolonged QT interval (long ST segment)", "T wave may be normal height", "Risk: Torsades de pointes"] },
    { condition: "Hypercalcaemia (Ca²⁺ ↑)", color: WHITE, changes: ["Short QT interval (shortened ST)", "J-wave (Osborn) occasionally", "Bradycardia, PR prolongation in severe cases"] },
    { condition: "Digoxin effect", color: MUTED, changes: ["Down-sloping ST depression ('reverse tick' or 'hockey stick')", "T wave flattening/inversion", "PR prolongation (AV conduction slowing)", "Short QT; does not indicate toxicity alone"] },
    { condition: "QT-prolonging Drugs", color: ACCENT, changes: ["Class Ia antiarrhythmics (quinidine, procainamide)", "Class III antiarrhythmics (amiodarone, sotalol)", "Macrolide antibiotics (azithromycin, clarithromycin)", "Antipsychotics (haloperidol, quetiapine)", "Monitor QTc; risk of Torsades de pointes"] },
  ];

  const positions = [
    { x: 0.4, y: 0.9 }, { x: 3.42, y: 0.9 }, { x: 6.45, y: 0.9 },
    { x: 0.4, y: 3.2 }, { x: 3.42, y: 3.2 }, { x: 6.45, y: 3.2 },
  ];

  effects.forEach((e, i) => {
    const { x, y } = positions[i];
    card(slide, x, y, 2.88, 2.12, CARD_BG);
    slide.addShape(pres.shapes.RECTANGLE, { x, y, w: 2.88, h: 0.08, fill: { color: e.color }, line: { type: "none" } });
    slide.addText(e.condition, {
      x: x + 0.1, y: y + 0.14, w: 2.68, h: 0.3,
      fontSize: 10, bold: true, color: e.color, fontFace: "Calibri", margin: 0
    });
    const bullets = e.changes.map((t, j) => ({ text: t, options: { bullet: { code: "2022" }, color: LIGHT_GRAY, fontSize: 8.5, breakLine: j < e.changes.length - 1 } }));
    slide.addText(bullets, {
      x: x + 0.1, y: y + 0.48, w: 2.68, h: 1.5,
      fontFace: "Calibri", margin: 0
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 11: Normal Intervals Quick Reference Table
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, GOLD);
  sectionHead(slide, "Quick Reference: Normal ECG Values", "Memorize these before reading any ECG");
  divider(slide, 0.65, GOLD);

  const tableData = [
    [
      { text: "Parameter",      options: { bold: true, fill: { color: "2A2000" }, color: GOLD, fontSize: 11 } },
      { text: "Normal Range",   options: { bold: true, fill: { color: "2A2000" }, color: GOLD, fontSize: 11 } },
      { text: "Abnormal If…",   options: { bold: true, fill: { color: "2A2000" }, color: GOLD, fontSize: 11 } },
      { text: "Clinical Significance", options: { bold: true, fill: { color: "2A2000" }, color: GOLD, fontSize: 11 } },
    ],
    ["Heart Rate",       "60–100 bpm",                 "< 60 bradycardia; > 100 tachycardia", "Pacemaker rate, autonomic tone, medications"],
    ["PR Interval",      "120–200 ms (3–5 small boxes)", "> 200 ms = 1st-degree AV block; < 120 ms = preexcitation", "AV nodal conduction; WPW if short"],
    ["QRS Duration",     "70–110 ms (< 3 small boxes)", "≥ 120 ms = bundle branch block",      "Ventricular conduction; wide → BBB or aberrancy"],
    ["QTc",              "< 440ms ♂ / < 460ms ♀",     "> 500ms = high Torsades risk",         "Drug review; electrolytes; congenital LQTS"],
    ["QRS Axis",         "−30° to +90°",                "< −30° LAD;  > +90° RAD",              "Fascicular block; hypertrophy; COPD"],
    ["P-wave duration",  "< 120 ms",                    "> 120ms = left atrial enlargement",    "Atrial disease; mitral pathology"],
    ["P-wave amplitude", "< 2.5 mm (limb leads)",       "> 2.5mm in II = RAE (P pulmonale)",    "Pulmonary hypertension; COPD"],
    ["R progression",    "Transition at V3 or V4",      "Poor R progression → anterior MI",     "Anterior wall infarction; LBBB"],
    ["ST segment",       "Isoelectric (±0.5mm)",         "Elevation or depression",               "Ischemia, pericarditis, Brugada, LV aneurysm"],
    ["T wave direction", "Concordant with QRS",          "Inversion = ischemia / strain / RBBB", "Follow for dynamic ischemia"],
  ];

  const formattedRows = tableData.map((row, i) => {
    if (i === 0) return row;
    const rowColor = i % 2 === 0 ? CARD_BG : MID_BG;
    return row.map((cell, j) => ({
      text: cell,
      options: {
        fill: { color: rowColor },
        color: j === 0 ? WHITE : (j === 1 ? ACCENT2 : (j === 2 ? GOLD : LIGHT_GRAY)),
        fontSize: 9.5,
      }
    }));
  });

  slide.addTable(formattedRows, {
    x: 0.4, y: 0.88, w: 9.2, h: 4.5,
    border: { pt: 0.5, color: "2A3A4A" },
    rowH: 0.41,
    colW: [1.65, 1.92, 2.68, 2.95],
    fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 12: Systematic Approach to ECG Reading
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);
  topBar(slide, ACCENT);
  sectionHead(slide, "Systematic 10-Step ECG Approach", "Never miss a finding — use the same order every time");
  divider(slide);

  const steps = [
    { n: "1", title: "Calibration",       desc: "Check paper speed (25mm/s) and gain (10mm=1mV). Look for artifacts." },
    { n: "2", title: "Rate",              desc: "300 ÷ large boxes (regular) or count × 6 over 10 seconds (irregular)." },
    { n: "3", title: "Rhythm",            desc: "Is it regular? Are all P waves identical? Is P:QRS ratio 1:1?" },
    { n: "4", title: "P Wave",            desc: "Present? Normal morphology? PR interval 120-200ms? Every P followed by QRS?" },
    { n: "5", title: "PR Interval",       desc: "Fixed or variable? Prolonged (>200ms) or short (<120ms)?" },
    { n: "6", title: "QRS Duration",      desc: "Narrow (<110ms) or wide (≥120ms)? Bundle branch block morphology?" },
    { n: "7", title: "Axis",              desc: "Check leads I and aVF. Calculate or estimate frontal plane axis." },
    { n: "8", title: "ST Segment",        desc: "Elevation? Depression? Contiguous leads? Reciprocal changes?" },
    { n: "9", title: "T Wave & QTc",      desc: "Inverted T waves? Peaked T waves? Calculate QTc with Bazett's formula." },
    { n: "10", title: "Overall Impression", desc: "Integrate all findings. Correlate with clinical context." },
  ];

  const cols = [steps.slice(0, 5), steps.slice(5)];
  cols.forEach((col, ci) => {
    col.forEach((s, si) => {
      const x = 0.4 + ci * 4.85;
      const y = 0.88 + si * 0.93;
      card(slide, x, y, 4.55, 0.82, CARD_BG);
      slide.addShape(pres.shapes.ELLIPSE, {
        x: x + 0.1, y: y + 0.12, w: 0.45, h: 0.45,
        fill: { color: ci === 0 ? ACCENT : ACCENT2 }, line: { type: "none" }
      });
      slide.addText(s.n, {
        x: x + 0.1, y: y + 0.12, w: 0.45, h: 0.45,
        fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0
      });
      slide.addText(s.title, {
        x: x + 0.65, y: y + 0.07, w: 3.75, h: 0.26,
        fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
      });
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        x: x + 0.65, y: y + 0.35, w: 3.75, h: 0.38,
        fontSize: 8.5, color: LIGHT_GRAY, fontFace: "Calibri", margin: 0
      });
    });
  });
}

// ─────────────────────────────────────────────────────────────────
// SLIDE 13: Summary / Key Takeaways
// ─────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  darkBg(slide);

  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 10, h: 0.55, fill: { color: ACCENT }, line: { type: "none" }
  });
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0.55, w: 10, h: 0.06, fill: { color: GOLD }, line: { type: "none" }
  });

  slide.addText("Key Takeaways", {
    x: 0.4, y: 0.7, w: 9.2, h: 0.55,
    fontSize: 28, bold: true, color: WHITE, fontFace: "Calibri", align: "center"
  });

  const takeaways = [
    { icon: "→", color: ACCENT,  text: "Every ECG wave has a direct physiological correlate — P (atrial depol), QRS (ventricular depol), T (ventricular repol)." },
    { icon: "→", color: ACCENT2, text: "Normal intervals: PR 120-200ms · QRS <110ms · QTc <440ms (♂) / <460ms (♀) · axis -30° to +90°." },
    { icon: "→", color: GOLD,    text: "Wide QRS (≥120ms) = bundle branch block or ventricular rhythm. LBBB obstructs MI diagnosis — apply Sgarbossa criteria." },
    { icon: "→", color: ACCENT,  text: "ST elevation in contiguous leads with reciprocal depression = STEMI until proven otherwise. Localise by territory." },
    { icon: "→", color: ACCENT2, text: "Peaked T waves = hyperkalaemia (tent sign); prominent U waves = hypokalaemia; short QT = hypercalcaemia." },
    { icon: "→", color: GOLD,    text: "Always use a systematic 10-step approach. ECG findings must be interpreted in clinical context — never in isolation." },
  ];

  takeaways.forEach((t, i) => {
    const y = 1.42 + i * 0.67;
    card(slide, 0.4, y, 9.2, 0.58, i % 2 === 0 ? CARD_BG : MID_BG);
    slide.addShape(pres.shapes.RECTANGLE, { x: 0.4, y, w: 0.12, h: 0.58, fill: { color: t.color }, line: { type: "none" } });
    slide.addText(t.text, {
      x: 0.64, y: y + 0.1, w: 8.82, h: 0.38,
      fontSize: 10, color: WHITE, fontFace: "Calibri", margin: 0
    });
  });

  slide.addText("Sources: Goldman-Cecil Medicine · Guyton & Hall Textbook of Medical Physiology · Rosen's Emergency Medicine", {
    x: 0, y: 5.3, w: 10, h: 0.25,
    fontSize: 8, color: MUTED, align: "center", fontFace: "Calibri", italic: true
  });
}

// ─────────────────────────────────────────────────────────────────
// SAVE
// ─────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/ecg-presentation/ECG_Interpretation.pptx" })
  .then(() => console.log("SUCCESS: ECG_Interpretation.pptx saved"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Successfully replaced 2 instance(s) of the string in '/home/daytona/workspace/ecg-presentation/build.js'