const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Treatment Plan for Heart Failure";
pres.author = "Final Year MBBS";

// ─── COLOR PALETTE ────────────────────────────────────────────────
const DARK_BG   = "0D1F3C";   // deep navy (dominant ~65%)
const MID_BG    = "1A3560";   // mid navy for content slides
const CARD_BG   = "112B52";   // slightly lighter card
const ACCENT    = "E8A020";   // amber/gold accent
const ACCENT2   = "3FBBE8";   // sky blue
const WHITE     = "FFFFFF";
const LIGHT_TXT = "C8D8F0";
const MUTED     = "8AAAD4";
const GREEN     = "27AE60";
const RED       = "E74C3C";
const YELLOW    = "F1C40F";

// ─── HELPER: section header bar ──────────────────────────────────
function addHeaderBar(slide, title, sub) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: DARK_BG } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 1.0, w: 10, h: 0.06, fill: { color: ACCENT } });
  slide.addText(title, { x: 0.3, y: 0.08, w: 7.5, h: 0.5, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });
  if (sub) {
    slide.addText(sub, { x: 0.3, y: 0.6, w: 9, h: 0.35, fontSize: 11, color: ACCENT, fontFace: "Calibri", italic: true, margin: 0 });
  }
  // slide number placeholder area
  slide.addText("", { x: 9.3, y: 0.05, w: 0.6, h: 0.4 });
}

// ─── HELPER: content slide background ────────────────────────────
function setContentBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: MID_BG } });
}

// ─── HELPER: bullet list ─────────────────────────────────────────
function makeBullets(items, opts = {}) {
  return items.map((item, i) => {
    const isLast = i === items.length - 1;
    if (typeof item === "string") {
      return { text: item, options: { bullet: { code: "2022" }, color: opts.color || LIGHT_TXT, fontSize: opts.fontSize || 14, fontFace: "Calibri", breakLine: !isLast } };
    }
    // object with indent
    return { text: item.text, options: { bullet: { code: "25B8", indent: item.indent || 20 }, color: item.color || opts.subColor || MUTED, fontSize: opts.subFontSize || 12, fontFace: "Calibri", breakLine: !isLast } };
  });
}

// ─── HELPER: info card ───────────────────────────────────────────
function addCard(slide, x, y, w, h, title, lines, titleColor, bgColor) {
  slide.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: bgColor || CARD_BG }, line: { color: ACCENT, width: 1.2 }, rectRadius: 0.08 });
  if (title) {
    slide.addText(title, { x: x + 0.1, y: y + 0.08, w: w - 0.2, h: 0.32, fontSize: 12, bold: true, color: titleColor || ACCENT, fontFace: "Calibri", margin: 0 });
  }
  if (lines && lines.length) {
    const bulletItems = lines.map((l, i) => ({
      text: l, options: { bullet: { code: "2022" }, color: LIGHT_TXT, fontSize: 11, fontFace: "Calibri", breakLine: i < lines.length - 1 }
    }));
    slide.addText(bulletItems, { x: x + 0.15, y: y + (title ? 0.42 : 0.12), w: w - 0.25, h: h - (title ? 0.55 : 0.22), valign: "top" });
  }
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
  // decorative left stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: ACCENT } });
  // bottom bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.9, w: 10, h: 0.725, fill: { color: "091729" } });

  s.addText("TREATMENT PLAN FOR", { x: 0.5, y: 1.0, w: 9, h: 0.5, fontSize: 20, color: ACCENT2, fontFace: "Calibri", bold: false, charSpacing: 4, align: "center" });
  s.addText("HEART FAILURE", { x: 0.5, y: 1.5, w: 9, h: 1.0, fontSize: 46, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });

  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 2.65, w: 3, h: 0.06, fill: { color: ACCENT } });

  s.addText("Evidence-Based Approach for Final Year MBBS", { x: 0.5, y: 2.85, w: 9, h: 0.45, fontSize: 15, color: LIGHT_TXT, fontFace: "Calibri", italic: true, align: "center" });
  s.addText("Based on: Braunwald's Heart Disease | Goldman-Cecil Medicine | Goodman & Gilman's Pharmacology", {
    x: 0.5, y: 4.88, w: 9, h: 0.35, fontSize: 9.5, color: MUTED, fontFace: "Calibri", align: "center"
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 – OUTLINE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Presentation Outline", "What we will cover today");

  const topics = [
    "Definition & Epidemiology",
    "Pathophysiology & Neurohormonal Activation",
    "Aetiology & Precipitating Factors",
    "Clinical Features & NYHA Classification",
    "Diagnosis: ECG, Echo, BNP, CXR",
    "ACC/AHA Staging System",
    "Goals of Treatment",
    "Non-Pharmacological Management",
    "Pharmacological Management — HFrEF",
    "The Four Pillars (GDMT)",
    "Additional Drug Therapies",
    "Management of HFpEF",
    "Acute / Decompensated Heart Failure",
    "Device Therapy: ICD, CRT",
    "Advanced Heart Failure & Transplant",
    "Monitoring & Follow-up",
    "Key Exam Points",
  ];

  // Two columns
  const col1 = topics.slice(0, 9);
  const col2 = topics.slice(9);

  const bullets1 = col1.map((t, i) => ({
    text: `${i + 1}.  ${t}`,
    options: { bullet: false, color: LIGHT_TXT, fontSize: 12.5, fontFace: "Calibri", breakLine: i < col1.length - 1 }
  }));
  const bullets2 = col2.map((t, i) => ({
    text: `${i + 10}.  ${t}`,
    options: { bullet: false, color: LIGHT_TXT, fontSize: 12.5, fontFace: "Calibri", breakLine: i < col2.length - 1 }
  }));

  s.addText(bullets1, { x: 0.35, y: 1.2, w: 4.5, h: 4.1, valign: "top" });
  s.addText(bullets2, { x: 5.1, y: 1.2, w: 4.5, h: 4.1, valign: "top" });
  // divider
  s.addShape(pres.ShapeType.rect, { x: 4.95, y: 1.2, w: 0.04, h: 4.1, fill: { color: ACCENT } });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 – DEFINITION & EPIDEMIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Definition & Epidemiology");

  s.addText("Definition", { x: 0.35, y: 1.15, w: 9, h: 0.35, fontSize: 14, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
  s.addShape(pres.ShapeType.roundRect, { x: 0.35, y: 1.55, w: 9.3, h: 0.85, fill: { color: CARD_BG }, line: { color: ACCENT2, width: 1 }, rectRadius: 0.07 });
  s.addText(
    "Heart failure is a clinical syndrome in which the heart fails to meet the metabolic requirements of the body at normal filling pressures, resulting in dyspnoea, fatigue, and/or fluid retention.",
    { x: 0.55, y: 1.6, w: 9.0, h: 0.75, fontSize: 13, color: WHITE, fontFace: "Calibri", italic: false }
  );

  s.addText("Epidemiology", { x: 0.35, y: 2.55, w: 9, h: 0.35, fontSize: 14, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });

  // stat boxes
  const stats = [
    { val: "26M+", label: "Affected globally" },
    { val: "~10M", label: "Estimated in India" },
    { val: "50%", label: "5-yr mortality" },
    { val: "25%", label: "30-day readmission" },
  ];
  stats.forEach((st, i) => {
    const x = 0.35 + i * 2.4;
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.98, w: 2.1, h: 1.18, fill: { color: CARD_BG }, line: { color: ACCENT, width: 1.2 }, rectRadius: 0.1 });
    s.addText(st.val, { x, y: 3.05, w: 2.1, h: 0.55, fontSize: 24, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
    s.addText(st.label, { x, y: 3.6, w: 2.1, h: 0.45, fontSize: 11, color: LIGHT_TXT, fontFace: "Calibri", align: "center" });
  });

  s.addText([
    { text: "India: ", options: { bold: true, color: ACCENT2, fontSize: 12, fontFace: "Calibri" } },
    { text: "Rheumatic heart disease remains a leading cause in younger patients (unlike the West). Ischaemic heart disease and hypertension dominate in adults >40 years.", options: { color: LIGHT_TXT, fontSize: 12, fontFace: "Calibri" } }
  ], { x: 0.35, y: 4.25, w: 9.3, h: 0.7, valign: "middle" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 – PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Pathophysiology", "Neurohormonal Activation & LV Remodelling");

  // Central box
  s.addShape(pres.ShapeType.roundRect, { x: 3.7, y: 1.8, w: 2.6, h: 0.8, fill: { color: RED + "CC" }, line: { color: RED, width: 1 }, rectRadius: 0.1 });
  s.addText("Cardiac Injury\n(MI, HTN, Valvular)", { x: 3.7, y: 1.82, w: 2.6, h: 0.76, fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });

  // Arrow down
  s.addShape(pres.ShapeType.rect, { x: 4.96, y: 2.62, w: 0.08, h: 0.35, fill: { color: ACCENT } });

  // LV Remodelling box
  s.addShape(pres.ShapeType.roundRect, { x: 3.7, y: 2.98, w: 2.6, h: 0.65, fill: { color: CARD_BG }, line: { color: ACCENT, width: 1.2 }, rectRadius: 0.08 });
  s.addText("↓ Cardiac Output → LV Remodelling", { x: 3.7, y: 2.98, w: 2.6, h: 0.65, fontSize: 11, bold: true, color: ACCENT, fontFace: "Calibri", align: "center", valign: "middle" });

  // Left branch: RAAS
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 2.1, w: 2.8, h: 2.35, fill: { color: CARD_BG }, line: { color: ACCENT2, width: 1 }, rectRadius: 0.08 });
  s.addText("RAAS Activation", { x: 0.3, y: 2.15, w: 2.8, h: 0.3, fontSize: 12, bold: true, color: ACCENT2, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "↑ Angiotensin II",
    "Vasoconstriction",
    "↑ Aldosterone",
    "Na+ & H2O retention",
    "Myocyte apoptosis",
    "Ventricular fibrosis",
  ], { fontSize: 11 }), { x: 0.4, y: 2.5, w: 2.6, h: 1.85, valign: "top" });

  // Right branch: SNS
  s.addShape(pres.ShapeType.roundRect, { x: 6.9, y: 2.1, w: 2.8, h: 2.35, fill: { color: CARD_BG }, line: { color: YELLOW, width: 1 }, rectRadius: 0.08 });
  s.addText("SNS Activation", { x: 6.9, y: 2.15, w: 2.8, h: 0.3, fontSize: 12, bold: true, color: YELLOW, fontFace: "Calibri", align: "center" });
  s.addText(makeBullets([
    "↑ Norepinephrine",
    "Tachycardia",
    "↑ Cardiac afterload",
    "β-receptor downregulation",
    "Myocyte toxicity",
    "Arrhythmias",
  ], { fontSize: 11 }), { x: 7.0, y: 2.5, w: 2.6, h: 1.85, valign: "top" });

  // Connecting lines (drawn as thin rectangles)
  s.addShape(pres.ShapeType.rect, { x: 3.1, y: 2.22, w: 0.62, h: 0.05, fill: { color: ACCENT2 } });
  s.addShape(pres.ShapeType.rect, { x: 6.3, y: 2.22, w: 0.62, h: 0.05, fill: { color: YELLOW } });

  s.addText("Both pathways drive adverse cardiac remodelling → progressive pump failure", {
    x: 0.3, y: 4.65, w: 9.4, h: 0.4, fontSize: 11.5, color: MUTED, fontFace: "Calibri", italic: true, align: "center"
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 – AETIOLOGY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Aetiology of Heart Failure", "Common causes in Indian clinical practice");

  const causes = [
    { title: "Ischaemic Heart Disease", color: RED, items: ["Coronary artery disease", "Acute MI / post-MI LV dysfunction", "Most common cause in adults >40 yrs"] },
    { title: "Hypertensive Heart Disease", color: ACCENT, items: ["Pressure overload → LV hypertrophy", "Diastolic dysfunction common", "Increasing prevalence in India"] },
    { title: "Valvular Heart Disease", color: ACCENT2, items: ["Rheumatic mitral/aortic disease", "Dominant in younger Indians", "Volume & pressure overload"] },
    { title: "Cardiomyopathies", color: GREEN, items: ["Dilated (idiopathic, alcohol, viral)", "Hypertrophic (HOCM)", "Peripartum cardiomyopathy"] },
    { title: "Other Causes", color: YELLOW, items: ["Anaemia (hookworm — India)", "Thyrotoxicosis, beriberi", "Congenital heart disease, COPD"] },
  ];

  causes.forEach((c, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.3 + col * 3.2;
    const y = 1.25 + row * 2.1;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.0, h: 1.95, fill: { color: CARD_BG }, line: { color: c.color, width: 1.5 }, rectRadius: 0.1 });
    s.addText(c.title, { x: x + 0.1, y: y + 0.08, w: 2.8, h: 0.32, fontSize: 11.5, bold: true, color: c.color, fontFace: "Calibri", margin: 0 });
    s.addText(makeBullets(c.items, { fontSize: 11 }), { x: x + 0.1, y: y + 0.44, w: 2.8, h: 1.4, valign: "top" });
  });

  s.addText("Precipitants: Infection (pneumonia), AF, PE, medication non-compliance, anaemia, renal failure, high salt intake", {
    x: 0.3, y: 5.22, w: 9.4, h: 0.3, fontSize: 10.5, color: MUTED, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 – CLASSIFICATION: NYHA & ACC/AHA
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Classification Systems", "NYHA Functional Classes & ACC/AHA Stages");

  // NYHA table
  s.addText("NYHA Functional Classification", { x: 0.3, y: 1.15, w: 4.6, h: 0.35, fontSize: 13, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
  const nyha = [
    { cls: "I", desc: "No limitation; ordinary activity does not cause symptoms", col: GREEN },
    { cls: "II", desc: "Slight limitation; comfortable at rest but ordinary activity causes symptoms", col: YELLOW },
    { cls: "III", desc: "Marked limitation; less-than-ordinary activity causes symptoms", col: ACCENT },
    { cls: "IV", desc: "Symptoms at rest; inability to carry out any activity without discomfort", col: RED },
  ];
  nyha.forEach((row, i) => {
    const y = 1.58 + i * 0.9;
    s.addShape(pres.ShapeType.roundRect, { x: 0.3, y, w: 4.6, h: 0.82, fill: { color: CARD_BG }, line: { color: row.col, width: 1 }, rectRadius: 0.07 });
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.58, h: 0.82, fill: { color: row.col + "55" } });
    s.addText(`Class\n${row.cls}`, { x: 0.3, y, w: 0.58, h: 0.82, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(row.desc, { x: 1.0, y: y + 0.08, w: 3.8, h: 0.66, fontSize: 11.5, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
  });

  // ACC/AHA
  s.addText("ACC/AHA Staging (A–D)", { x: 5.25, y: 1.15, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: ACCENT2, fontFace: "Calibri", margin: 0 });
  const aha = [
    { stage: "A", desc: "At risk; no structural heart disease (HTN, DM, family Hx)", col: GREEN },
    { stage: "B", desc: "Structural heart disease; no symptoms of HF", col: YELLOW },
    { stage: "C", desc: "Structural heart disease; prior or current HF symptoms", col: ACCENT },
    { stage: "D", desc: "Refractory HF; advanced interventions required", col: RED },
  ];
  aha.forEach((row, i) => {
    const y = 1.58 + i * 0.9;
    s.addShape(pres.ShapeType.roundRect, { x: 5.25, y, w: 4.4, h: 0.82, fill: { color: CARD_BG }, line: { color: row.col, width: 1 }, rectRadius: 0.07 });
    s.addShape(pres.ShapeType.rect, { x: 5.25, y, w: 0.62, h: 0.82, fill: { color: row.col + "55" } });
    s.addText(`Stage\n${row.stage}`, { x: 5.25, y, w: 0.62, h: 0.82, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(row.desc, { x: 6.0, y: y + 0.08, w: 3.5, h: 0.66, fontSize: 11.5, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
  });

  // divider
  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.1, w: 0.04, h: 4.4, fill: { color: ACCENT } });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 – DIAGNOSIS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Diagnosis of Heart Failure", "Investigations: ECG | Echo | BNP | CXR");

  const cards = [
    {
      title: "Echocardiography (Gold Standard)",
      col: ACCENT2,
      lines: [
        "LVEF: HFrEF <40%, HFmrEF 41-49%, HFpEF ≥50%",
        "LV dimensions, wall motion abnormalities",
        "Valvular pathology, pericardial effusion",
        "Estimated filling pressures (E/e' ratio)",
      ],
    },
    {
      title: "Biomarkers",
      col: ACCENT,
      lines: [
        "BNP >100 pg/mL or NT-proBNP >300 pg/mL: supports HF",
        "Excludes HF if BNP <35 pg/mL",
        "Useful for monitoring and prognosis",
        "Elevated in AF, PE, renal failure (false positive)",
      ],
    },
    {
      title: "Chest X-Ray",
      col: GREEN,
      lines: [
        "Cardiomegaly: cardiothoracic ratio >0.5",
        "Upper lobe blood diversion (ULBD)",
        "Kerley B lines (interstitial oedema)",
        "Bat-wing pattern (alveolar oedema)",
      ],
    },
    {
      title: "ECG",
      col: YELLOW,
      lines: [
        "LVH, LBBB (suggests ischaemic/dilated CMP)",
        "Q waves: prior MI",
        "AF: common trigger/consequence",
        "Normal ECG has high negative predictive value",
      ],
    },
    {
      title: "Blood Tests",
      col: RED,
      lines: [
        "FBC (anaemia), RFT (CKD), LFTs",
        "Thyroid function (thyrotoxicosis)",
        "Serum electrolytes (K+, Na+)",
        "Fasting glucose / HbA1c",
      ],
    },
    {
      title: "Additional",
      col: MUTED,
      lines: [
        "Cardiac MRI: myocarditis, infiltrative disease",
        "Coronary angiography if ischaemia suspected",
        "6-minute walk test (functional capacity)",
        "Endomyocardial biopsy: rarely indicated",
      ],
    },
  ];

  cards.forEach((c, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.2 + col * 3.28;
    const y = 1.2 + row * 2.05;
    addCard(s, x, y, 3.1, 1.9, c.title, c.lines, c.col);
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 – GOALS OF TREATMENT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Goals of Treatment", "A three-pronged approach");

  const goals = [
    {
      num: "01",
      title: "Improve Symptoms & Quality of Life",
      color: ACCENT2,
      bullets: [
        "Relieve dyspnoea, oedema, and fatigue",
        "Improve exercise tolerance (NYHA class)",
        "Prevent hospitalisations",
      ],
    },
    {
      num: "02",
      title: "Slow Disease Progression",
      color: ACCENT,
      bullets: [
        "Reverse or prevent LV remodelling",
        "Neurohormonal blockade (RAAS + SNS)",
        "Optimise guideline-directed medical therapy",
      ],
    },
    {
      num: "03",
      title: "Reduce Mortality",
      color: GREEN,
      bullets: [
        "Mortality benefit proven for: ACEi/ARB/ARNI, β-blockers, MRA, SGLT2i",
        "ICD for sudden cardiac death prevention",
        "CRT for dyssynchrony",
      ],
    },
  ];

  goals.forEach((g, i) => {
    const x = 0.3 + i * 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.25, w: 3.1, h: 4.0, fill: { color: CARD_BG }, line: { color: g.color, width: 1.5 }, rectRadius: 0.1 });
    s.addText(g.num, { x, y: 1.35, w: 3.1, h: 0.7, fontSize: 36, bold: true, color: g.color + "40", fontFace: "Calibri", align: "center" });
    s.addText(g.title, { x: x + 0.15, y: 2.1, w: 2.8, h: 0.55, fontSize: 13, bold: true, color: g.color, fontFace: "Calibri", align: "center" });
    s.addShape(pres.ShapeType.rect, { x: x + 0.5, y: 2.7, w: 2.1, h: 0.04, fill: { color: g.color } });
    s.addText(makeBullets(g.bullets, { fontSize: 12 }), { x: x + 0.15, y: 2.82, w: 2.8, h: 2.1, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 – NON-PHARMACOLOGICAL MANAGEMENT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Non-Pharmacological Management", "Lifestyle modifications — equally important as drugs");

  const items = [
    { icon: "🧂", title: "Salt Restriction", body: "< 2–3 g sodium/day. Avoid high-salt Indian foods: pickles, papadums, processed snacks." },
    { icon: "💧", title: "Fluid Restriction", body: "< 1.5–2 L/day in severe HF (NYHA III–IV). Daily weight monitoring; report >2 kg gain in 2 days." },
    { icon: "🏃", title: "Exercise & Cardiac Rehab", body: "Supervised aerobic exercise in stable HF (NYHA I–III). Improves VO2 max, QoL, and hospital admissions (HF-ACTION trial)." },
    { icon: "🚭", title: "Smoking & Alcohol Cessation", body: "Alcohol cardiomyopathy: abstinence may partially reverse LV dysfunction. Smoking worsens ischaemia." },
    { icon: "💊", title: "Medication Compliance", body: "Major cause of decompensation in India. Patient education, pill organisers, family support essential." },
    { icon: "💉", title: "Vaccinations", body: "Annual influenza vaccine. Pneumococcal vaccine. Reduces hospitalisation risk." },
    { icon: "⚖️", title: "Weight Management", body: "Treat obesity (BMI > 30). However, avoid rapid weight loss in cardiac cachexia." },
    { icon: "🛏️", title: "Sleep & Breathing", body: "Screen for obstructive sleep apnoea. CPAP therapy improves BP and LV function." },
  ];

  items.forEach((item, i) => {
    const col = i % 4;
    const row = Math.floor(i / 4);
    const x = 0.2 + col * 2.45;
    const y = 1.22 + row * 2.1;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 2.3, h: 1.95, fill: { color: CARD_BG }, line: { color: ACCENT, width: 0.8 }, rectRadius: 0.08 });
    s.addText(item.icon + " " + item.title, { x: x + 0.1, y: y + 0.08, w: 2.1, h: 0.35, fontSize: 11.5, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
    s.addText(item.body, { x: x + 0.1, y: y + 0.46, w: 2.1, h: 1.38, fontSize: 10.5, color: LIGHT_TXT, fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 – OVERVIEW: PHARMACOLOGICAL APPROACH
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Pharmacological Management — Overview", "HFrEF vs HFpEF strategies differ significantly");

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.18, w: 4.5, h: 4.0, fill: { color: CARD_BG }, line: { color: ACCENT, width: 1.5 }, rectRadius: 0.1 });
  s.addText("HFrEF (EF < 40%)", { x: 0.3, y: 1.25, w: 4.5, h: 0.4, fontSize: 15, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
  s.addText("Evidence-based mortality-reducing therapy:", { x: 0.5, y: 1.72, w: 4.1, h: 0.3, fontSize: 11.5, color: ACCENT2, fontFace: "Calibri", italic: true });
  s.addText(makeBullets([
    "ACE inhibitor / ARB / ARNI (sacubitril-valsartan)",
    "Beta-blocker (bisoprolol, carvedilol, metoprolol)",
    "Mineralocorticoid receptor antagonist (spironolactone)",
    "SGLT2 inhibitor (dapagliflozin / empagliflozin)",
    "Loop diuretics for symptom relief (furosemide)",
    "Ivabradine (if HR ≥70, sinus rhythm)",
    "Hydralazine + nitrate (if ACEi/ARB intolerant)",
    "Digoxin (rate control, selected cases)",
  ], { fontSize: 11.5 }), { x: 0.45, y: 2.08, w: 4.2, h: 3.0, valign: "top" });

  s.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 1.18, w: 4.5, h: 4.0, fill: { color: CARD_BG }, line: { color: ACCENT2, width: 1.5 }, rectRadius: 0.1 });
  s.addText("HFpEF (EF ≥ 50%)", { x: 5.2, y: 1.25, w: 4.5, h: 0.4, fontSize: 15, bold: true, color: ACCENT2, fontFace: "Calibri", align: "center" });
  s.addText("Symptom control & risk factor management:", { x: 5.4, y: 1.72, w: 4.1, h: 0.3, fontSize: 11.5, color: ACCENT, fontFace: "Calibri", italic: true });
  s.addText(makeBullets([
    "Diuretics for congestion (furosemide, torasemide)",
    "Treat underlying cause: HTN, AF, CAD, DM",
    "SGLT2 inhibitors — benefit shown (EMPEROR-Preserved)",
    "Spironolactone — marginal benefit (TOPCAT trial)",
    "ARBs (candesartan) — modest benefit",
    "No proven mortality benefit for ACEi or β-blocker",
    "Rate control in AF with beta-blockers/digoxin",
    "Cardiac rehab and exercise training",
  ], { fontSize: 11.5 }), { x: 5.4, y: 2.08, w: 4.1, h: 3.0, valign: "top" });

  // divider
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.18, w: 0.04, h: 4.0, fill: { color: ACCENT } });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 – THE FOUR PILLARS (GDMT)
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "The Four Pillars of GDMT in HFrEF", "Guideline-Directed Medical Therapy (ACC/AHA 2022)");

  // Central text
  s.addText("Each pillar independently reduces mortality and hospitalisation when added to standard care", {
    x: 0.8, y: 1.12, w: 8.4, h: 0.35, fontSize: 11.5, color: MUTED, fontFace: "Calibri", italic: true, align: "center"
  });

  const pillars = [
    {
      title: "ARNI / ACE-I / ARB",
      subtitle: "Sacubitril-Valsartan preferred",
      color: ACCENT,
      items: ["Sacubitril-valsartan (PARADIGM-HF): ↓ 20% CV death vs enalapril", "Start: Sacubitril 24/26 mg BD; target 97/103 mg BD", "Contraindicated: bilateral RAS, angioedema, with ACEi", "ACEi (enalapril 2.5 → 20 mg BD) if ARNI not available"],
    },
    {
      title: "Beta-Blocker",
      subtitle: "Bisoprolol / Carvedilol / Metoprolol",
      color: ACCENT2,
      items: ["↓ Mortality by 34% (MERIT-HF, CIBIS-II, COPERNICUS)", "Start LOW, go SLOW: bisoprolol 1.25 mg OD → 10 mg OD", "Do NOT start in acute decompensation", "Benefits in all NYHA II–IV regardless of aetiology"],
    },
    {
      title: "MRA",
      subtitle: "Spironolactone / Eplerenone",
      color: GREEN,
      items: ["RALES: spironolactone ↓ 30% mortality in NYHA III–IV", "Spironolactone 25–50 mg OD; monitor K+ and creatinine", "Gynecomastia with spironolactone → switch to eplerenone", "Contraindicated: K+ >5.0 mmol/L, creatinine >220 μmol/L"],
    },
    {
      title: "SGLT2 Inhibitor",
      subtitle: "Dapagliflozin / Empagliflozin",
      color: YELLOW,
      items: ["DAPA-HF: dapagliflozin ↓ worsening HF & CV death by 26%", "Benefits independent of diabetes status", "Mechanism: osmotic diuresis, anti-fibrotic, metabolic effects", "Dapagliflozin 10 mg OD; caution in eGFR <20 ml/min"],
    },
  ];

  pillars.forEach((p, i) => {
    const x = 0.2 + i * 2.43;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.55, w: 2.28, h: 3.8, fill: { color: CARD_BG }, line: { color: p.color, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.rect, { x, y: 1.55, w: 2.28, h: 0.55, fill: { color: p.color + "33" } });
    s.addText(p.title, { x, y: 1.58, w: 2.28, h: 0.3, fontSize: 12, bold: true, color: p.color, fontFace: "Calibri", align: "center" });
    s.addText(p.subtitle, { x, y: 1.88, w: 2.28, h: 0.2, fontSize: 9.5, color: MUTED, fontFace: "Calibri", align: "center", italic: true });
    s.addText(p.items.map((it, ii) => ({ text: it, options: { bullet: { code: "25B8" }, color: LIGHT_TXT, fontSize: 10.5, fontFace: "Calibri", breakLine: ii < p.items.length - 1 } })),
      { x: x + 0.1, y: 2.18, w: 2.08, h: 3.1, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 12 – DIURETICS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Diuretics in Heart Failure", "Symptom relief — not proven to reduce mortality alone");

  s.addText("LOOP DIURETICS — First-line for fluid overload", { x: 0.3, y: 1.15, w: 9.4, h: 0.38, fontSize: 13.5, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });

  const loopData = [
    ["Drug", "Starting Dose", "Max Dose", "Key Features"],
    ["Furosemide", "20–40 mg OD/BD", "400–600 mg/day", "First-line; impaired bioavailability in oedema"],
    ["Torasemide", "5–10 mg OD", "200 mg/day", "Better oral bioavailability; preferred in chronic HF"],
    ["Bumetanide", "0.5–1 mg OD", "10 mg/day", "More potent; useful in furosemide resistance"],
  ];

  loopData.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const x = 0.3 + ci * 2.35;
      const y = 1.6 + ri * 0.52;
      s.addShape(pres.ShapeType.rect, {
        x, y, w: 2.35, h: 0.52,
        fill: { color: ri === 0 ? ACCENT + "44" : CARD_BG },
        line: { color: ri === 0 ? ACCENT : MUTED + "55", width: 0.7 }
      });
      s.addText(cell, { x: x + 0.07, y: y + 0.05, w: 2.2, h: 0.42, fontSize: ri === 0 ? 11.5 : 11, bold: ri === 0, color: ri === 0 ? ACCENT : LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
    });
  });

  s.addText("OTHER DIURETICS", { x: 0.3, y: 3.76, w: 9.4, h: 0.35, fontSize: 13, bold: true, color: ACCENT2, fontFace: "Calibri", margin: 0 });

  const others = [
    { type: "Thiazides\n(Hydrochlorothiazide,\nMetolazone)", info: "Synergistic with loop diuretics in diuretic resistance (sequential nephron blockade). Monitor K+ and creatinine closely." },
    { type: "Spironolactone\n(MRA, K+-sparing)", info: "25–50 mg OD. Reduces aldosterone escape. Prevents K+ loss. Proven mortality benefit (RALES trial)." },
    { type: "SGLT2 Inhibitors\n(Dapagliflozin)", info: "Osmotic natriuresis. Reduce loop diuretic resistance. Cardio-renal protective beyond diuresis." },
  ];

  others.forEach((o, i) => {
    const x = 0.3 + i * 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y: 4.15, w: 3.1, h: 1.2, fill: { color: CARD_BG }, line: { color: ACCENT2, width: 1 }, rectRadius: 0.08 });
    s.addText(o.type, { x: x + 0.1, y: 4.18, w: 1.2, h: 1.12, fontSize: 10.5, bold: true, color: ACCENT2, fontFace: "Calibri", valign: "middle" });
    s.addText(o.info, { x: x + 1.35, y: 4.18, w: 1.65, h: 1.12, fontSize: 10.5, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 13 – ACE INHIBITORS & ARNI
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "ACE Inhibitors, ARBs & ARNI", "RAAS Blockade — Cornerstone of HFrEF therapy");

  addCard(s, 0.25, 1.18, 4.5, 2.05, "ACE Inhibitors", [
    "Block conversion of Ang I → Ang II; also prevent bradykinin breakdown",
    "Proven agents: Enalapril 2.5–20 mg BD, Ramipril 2.5–10 mg BD, Lisinopril 5–40 mg OD",
    "CONSENSUS, SOLVD trials: ↓ mortality 16–40%",
    "S/E: Dry cough (bradykinin), hypotension (1st dose), hyperkalaemia, angioedema (rare)",
  ], ACCENT);

  addCard(s, 5.25, 1.18, 4.5, 2.05, "ARBs (if ACEi intolerant)", [
    "Block AT1 receptor; no bradykinin accumulation → no cough",
    "Val-HeFT, CHARM: valsartan, candesartan reduce hospitalisation",
    "Candesartan 4–32 mg OD, Valsartan 40–160 mg BD",
    "Use when ACEi not tolerated due to cough or angioedema",
  ], ACCENT2);

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.32, w: 9.5, h: 0.04, fill: { color: ACCENT } });

  addCard(s, 0.25, 3.42, 9.5, 1.9, "ARNI — Sacubitril/Valsartan (Entresto) ★ Preferred in HFrEF", [
    "Dual mechanism: Sacubitril inhibits neprilysin (↑ natriuretic peptides BNP/ANP) + valsartan blocks AT1",
    "PARADIGM-HF trial: ↓ CV mortality by 20% and HF hospitalisation by 21% vs enalapril",
    "Dose: Start 24/26 mg BD → target 97/103 mg BD. Washout 36h required before starting after ACEi",
    "Contraindications: History of angioedema, NEVER combine with ACEi (risk of angioedema), bilateral RAS",
    "2022 ACC/AHA: Replace ACEi/ARB with ARNI in patients who can tolerate — Class I, Level A evidence",
  ], YELLOW);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 14 – BETA-BLOCKERS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Beta-Blockers in Heart Failure", "Counter SNS hyperactivation — proven mortality benefit");

  s.addText("Only THREE beta-blockers have proven mortality benefit in HFrEF:", {
    x: 0.3, y: 1.15, w: 9.4, h: 0.3, fontSize: 12.5, color: ACCENT, fontFace: "Calibri", italic: true
  });

  const drugs = [
    { name: "Carvedilol", trial: "COPERNICUS", detail: "Non-selective β + α1 blocker\nStart: 3.125 mg BD\nTarget: 25–50 mg BD\n↓ mortality 35% (severe HF)" },
    { name: "Bisoprolol", trial: "CIBIS-II", detail: "Cardioselective β1\nStart: 1.25 mg OD\nTarget: 10 mg OD\n↓ mortality 34%" },
    { name: "Metoprolol\nSuccinate", trial: "MERIT-HF", detail: "Cardioselective β1 (SR)\nStart: 12.5–25 mg OD\nTarget: 200 mg OD\n↓ mortality 34%" },
  ];

  drugs.forEach((d, i) => {
    const x = 0.3 + i * 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.55, w: 3.05, h: 2.2, fill: { color: CARD_BG }, line: { color: ACCENT2, width: 1.5 }, rectRadius: 0.1 });
    s.addText(d.name, { x, y: 1.6, w: 3.05, h: 0.42, fontSize: 16, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText(`Trial: ${d.trial}`, { x, y: 2.04, w: 3.05, h: 0.28, fontSize: 11, color: ACCENT, fontFace: "Calibri", align: "center", italic: true });
    s.addText(d.detail, { x: x + 0.15, y: 2.36, w: 2.75, h: 1.3, fontSize: 11.5, color: LIGHT_TXT, fontFace: "Calibri", valign: "top" });
  });

  s.addText("Practical Rules for Beta-Blocker Use", { x: 0.3, y: 3.88, w: 9.4, h: 0.32, fontSize: 13, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });

  s.addText(makeBullets([
    "Always start LOW, titrate SLOW — double dose every 2 weeks",
    "Do NOT start in acute decompensated HF (fluid overload, wet and cold)",
    "Do NOT stop abruptly — risk of rebound tachycardia and decompensation",
    "Use cautiously in: asthma (prefer bisoprolol), bradycardia, hypotension, severe peripheral vascular disease",
    "Heart rate target: 55–65 bpm at rest in sinus rhythm",
  ], { fontSize: 12 }), { x: 0.3, y: 4.25, w: 9.4, h: 1.2, valign: "top" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 15 – MRA & SGLT2 INHIBITORS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "MRA & SGLT2 Inhibitors", "Pillars 3 & 4 of GDMT");

  // MRA
  s.addText("Mineralocorticoid Receptor Antagonists (MRA)", { x: 0.3, y: 1.18, w: 4.5, h: 0.35, fontSize: 13, bold: true, color: GREEN, fontFace: "Calibri", margin: 0 });
  addCard(s, 0.3, 1.58, 4.5, 3.7, null, [
    "Spironolactone 25–50 mg OD (start 25 mg, target 50 mg)",
    "Eplerenone 25–50 mg OD (more selective, no gynaecomastia)",
    "RALES trial: spironolactone ↓ mortality by 30% in NYHA III–IV",
    "EPHESUS trial: eplerenone ↓ death after MI with systolic HF",
    "Mechanism: blocks aldosterone at myocardium & kidney → ↓ fibrosis, ↓ K+ loss",
    "MONITOR: K+ every 1–4 weeks after start. Stop if K+ >5.5 mmol/L",
    "Contraindications: K+ >5.0 mmol/L, creatinine >220 μmol/L, concurrent K+-sparing diuretics",
    "S/E of spironolactone: gynaecomastia, menstrual irregularity (switch to eplerenone)",
  ], GREEN);

  // SGLT2
  s.addText("SGLT2 Inhibitors (Gliflozins)", { x: 5.2, y: 1.18, w: 4.5, h: 0.35, fontSize: 13, bold: true, color: YELLOW, fontFace: "Calibri", margin: 0 });
  addCard(s, 5.2, 1.58, 4.5, 3.7, null, [
    "Dapagliflozin 10 mg OD — FDA approved for HFrEF & HFpEF",
    "Empagliflozin 10 mg OD — EMPEROR-Reduced & Preserved trials",
    "DAPA-HF: ↓ worsening HF + CV death by 26% (benefit in diabetics AND non-diabetics)",
    "Mechanism: osmotic natriuresis, anti-fibrotic, ↓ NHE1 exchanger, metabolic benefits",
    "EMPEROR-Preserved: SGLT2i reduce HF hospitalisations in HFpEF",
    "S/E: genital mycotic infections, DKA (rare, hold before surgery)",
    "Caution: eGFR < 20 ml/min; hold before contrast procedures",
    "NOW a STANDARD of care in HFrEF regardless of diabetes status",
  ], YELLOW);

  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 1.18, w: 0.04, h: 4.1, fill: { color: ACCENT } });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 16 – ADDITIONAL THERAPIES
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Additional Pharmacological Therapies", "Adjunctive drugs in specific situations");

  const drugs = [
    {
      title: "Ivabradine",
      color: ACCENT2,
      body: [
        "Inhibits I(f) \"funny\" channel in SA node → ↓ HR (sinus rhythm only)",
        "Indication: NYHA II–IV, EF ≤35%, HR ≥70 bpm on max tolerated β-blocker",
        "SHIFT trial: ↓ HF hospitalisations by 26%",
        "Dose: 5 mg BD → 7.5 mg BD. Contraindicated in AF",
        "S/E: Phosphenes (visual disturbances), bradycardia",
      ],
    },
    {
      title: "Hydralazine + ISDN",
      color: ACCENT,
      body: [
        "Venodilator (nitrate) + arteriodilator (hydralazine) = balanced pre/afterload reduction",
        "V-HeFT II: ↓ mortality, inferior to ACEi (enalapril)",
        "Use when: ACEi/ARB/ARNI not tolerated (renal failure, angioedema, bilateral RAS)",
        "Dose: Hydralazine 25–75 mg TDS + ISDN 20–40 mg TDS",
        "S/E: Drug-induced lupus (hydralazine), headache, tolerance (nitrate)",
      ],
    },
    {
      title: "Digoxin",
      color: YELLOW,
      body: [
        "Positive inotrope (inhibits Na+/K+-ATPase) + vagomimetic (↓ HR in AF)",
        "DIG trial: Reduces hospitalisations; no mortality benefit",
        "Indications: AF with rapid ventricular rate in HF; refractory HFrEF",
        "Dose: 0.125–0.25 mg OD. Target level: 0.5–0.9 ng/mL",
        "Toxicity: Nausea, yellow-green vision, AV block, ventricular arrhythmias; danger in hypokalaemia",
      ],
    },
    {
      title: "Vericiguat",
      color: GREEN,
      body: [
        "Soluble guanylate cyclase stimulator → ↑ cGMP → vasodilation",
        "VICTORIA trial: ↓ CV death + HF hospitalisation in worsening HFrEF",
        "Used in high-risk patients with recent HF decompensation",
        "Dose: 2.5 mg OD → target 10 mg OD. Cannot combine with PDE5 inhibitors",
      ],
    },
  ];

  drugs.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 5.0;
    const y = 1.18 + row * 2.18;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.75, h: 2.05, fill: { color: CARD_BG }, line: { color: d.color, width: 1.3 }, rectRadius: 0.1 });
    s.addText(d.title, { x: x + 0.12, y: y + 0.08, w: 4.5, h: 0.32, fontSize: 13, bold: true, color: d.color, fontFace: "Calibri", margin: 0 });
    s.addText(d.body.map((l, ii) => ({ text: l, options: { bullet: { code: "2022" }, color: LIGHT_TXT, fontSize: 11, fontFace: "Calibri", breakLine: ii < d.body.length - 1 } })),
      { x: x + 0.15, y: y + 0.44, w: 4.45, h: 1.52, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 17 – HFpEF MANAGEMENT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Management of HFpEF", "Heart Failure with Preserved Ejection Fraction (EF ≥ 50%)");

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.18, w: 9.4, h: 0.75, fill: { color: CARD_BG }, line: { color: RED, width: 1 }, rectRadius: 0.08 });
  s.addText([
    { text: "Key challenge: ", options: { bold: true, color: RED, fontSize: 12.5, fontFace: "Calibri" } },
    { text: "Unlike HFrEF, NO drug has consistently shown mortality benefit in HFpEF. Management focuses on symptom control and treating co-morbidities.", options: { color: LIGHT_TXT, fontSize: 12.5, fontFace: "Calibri" } }
  ], { x: 0.45, y: 1.22, w: 9.1, h: 0.65, valign: "middle" });

  const cols = [
    {
      title: "Diuretics (Symptom Control)",
      color: ACCENT,
      items: [
        "Furosemide / torasemide — reduce congestion",
        "Careful not to over-diurese (↓ preload critical)",
        "Most important for quality of life",
      ],
    },
    {
      title: "Treat Comorbidities",
      color: ACCENT2,
      items: [
        "Hypertension: ACEi/ARB/CCB/thiazide",
        "Atrial fibrillation: rate control (beta-blockers, digoxin)",
        "Diabetes: SGLT2i (EMPEROR-Preserved)",
        "CAD: revascularisation if indicated",
        "Obesity: weight reduction",
      ],
    },
    {
      title: "Emerging Therapies",
      color: GREEN,
      items: [
        "SGLT2i (dapagliflozin/empagliflozin) — ↓ HF hospitalisation (Class IIa)",
        "Spironolactone (TOPCAT) — borderline benefit, use for diuresis",
        "ARB (candesartan) — modest benefit",
        "Finerenone — ongoing trials",
      ],
    },
  ];

  cols.forEach((c, i) => {
    const x = 0.3 + i * 3.25;
    addCard(s, x, 2.05, 3.1, 3.3, c.title, c.items, c.color);
  });

  s.addText("★  REMEMBER: The term 'HFmrEF' (EF 41–49%) — treat similarly to HFrEF; evidence is extrapolated", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 10.5, color: ACCENT, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 18 – ACUTE DECOMPENSATED HEART FAILURE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Acute Decompensated Heart Failure (ADHF)", "Emergency management");

  // Haemodynamic profiles
  s.addText("Haemodynamic Profiles: The 'Wet/Dry & Warm/Cold' Framework", { x: 0.3, y: 1.18, w: 9.4, h: 0.32, fontSize: 12.5, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });

  const matrix = [
    ["", "WARM (good perfusion)", "COLD (poor perfusion)"],
    ["WET (congested)", "Warm & Wet (most common)\n→ IV diuretics", "Cold & Wet (cardiogenic shock)\n→ Inotropes + diuretics"],
    ["DRY (euvolaemic)", "Warm & Dry (stable)\n→ Optimise oral therapy", "Cold & Dry (low output)\n→ Cautious fluid challenge"],
  ];
  matrix.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const x = 0.3 + ci * 3.15;
      const y = 1.55 + ri * 0.75;
      const isHeader = ri === 0 || ci === 0;
      const isShock = ri === 1 && ci === 2;
      s.addShape(pres.ShapeType.rect, {
        x, y, w: 3.1, h: 0.72,
        fill: { color: isShock ? RED + "44" : isHeader ? ACCENT + "33" : CARD_BG },
        line: { color: ACCENT + "88", width: 0.7 }
      });
      s.addText(cell, { x: x + 0.07, y: y + 0.06, w: 2.96, h: 0.6, fontSize: isHeader ? 11 : 10.5, bold: isHeader, color: isHeader ? ACCENT : LIGHT_TXT, fontFace: "Calibri", valign: "middle", align: isHeader ? "center" : "left" });
    });
  });

  s.addText("Treatment of ADHF (Warm & Wet)", { x: 0.3, y: 3.85, w: 4.5, h: 0.32, fontSize: 13, bold: true, color: ACCENT2, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Sit patient upright; high-flow O2 / CPAP if SpO2 <94%",
    "IV furosemide 40–80 mg (or 2.5x oral dose); repeat q4–6h PRN",
    "IV GTN (nitroglycerine) if SBP >90 mmHg — reduces preload/afterload",
    "Morphine (cautiously) — anxiolysis, venodilation; risk respiratory depression",
    "Monitor urine output, daily weight, electrolytes, renal function",
  ], { fontSize: 11.5 }), { x: 0.3, y: 4.22, w: 4.5, h: 1.25, valign: "top" });

  s.addText("Cardiogenic Shock (Cold & Wet)", { x: 5.2, y: 3.85, w: 4.5, h: 0.32, fontSize: 13, bold: true, color: RED, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Inotropes: Dobutamine 2–20 μg/kg/min (β1 agonist)",
    "Noradrenaline if SBP <70 mmHg (vasopressor)",
    "Dopamine at low dose (renal perfusion — limited evidence)",
    "IABP (intra-aortic balloon pump) as bridge",
    "Early coronary angiography if ACS precipitated",
  ], { fontSize: 11.5 }), { x: 5.2, y: 4.22, w: 4.5, h: 1.25, valign: "top" });

  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 3.82, w: 0.04, h: 1.7, fill: { color: ACCENT } });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 19 – DEVICE THERAPY: ICD
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Device Therapy — ICD", "Implantable Cardioverter-Defibrillator");

  addCard(s, 0.3, 1.18, 9.4, 1.28, "What is an ICD?", [
    "An ICD continuously monitors heart rhythm and delivers a shock to terminate life-threatening ventricular arrhythmias (VF, VT) that cause sudden cardiac death (SCD).",
    "SCD accounts for ~50% of deaths in HFrEF patients — ICD prevents this.",
  ], ACCENT2);

  s.addText("Indications (Class I — ACC/AHA):", { x: 0.3, y: 2.6, w: 9.4, h: 0.35, fontSize: 13.5, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "PRIMARY PREVENTION: LVEF ≤35% despite ≥3 months of optimal GDMT, NYHA class II–III, expected survival >1 year",
    "SECONDARY PREVENTION: Survivors of sustained VT/VF not due to a reversible cause",
    "Post-MI: LVEF <35% at ≥40 days after MI, NYHA II–III on GDMT",
    "Non-ischaemic dilated cardiomyopathy: LVEF ≤35% on GDMT for ≥3 months (DEFINITE trial)",
  ], { fontSize: 12 }), { x: 0.3, y: 3.0, w: 9.4, h: 1.25, valign: "top" });

  s.addText("Important Points:", { x: 0.3, y: 4.35, w: 9.4, h: 0.32, fontSize: 13, bold: true, color: RED, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Wait 40 days post-MI before reassessing EF — early revascularisation/GDMT may improve EF",
    "GDMT must be optimised for ≥3 months before ICD implant (EF may recover)",
    "NOT indicated in NYHA class IV unless bridge to transplant/CRT-D",
    "ICD does NOT improve symptoms or prevent HF progression — it ONLY prevents SCD",
  ], { fontSize: 12 }), { x: 0.3, y: 4.72, w: 9.4, h: 0.85, valign: "top" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 20 – DEVICE THERAPY: CRT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Device Therapy — CRT", "Cardiac Resynchronisation Therapy");

  addCard(s, 0.3, 1.18, 9.4, 0.95, "Rationale", [
    "In ~30% of HFrEF patients, bundle branch block (especially LBBB) causes dyssynchronous ventricular contraction, worsening pump function. CRT paces both ventricles simultaneously (biventricular pacing) to restore synchrony.",
  ], ACCENT2);

  s.addText("CRT Indications (Class I):", { x: 0.3, y: 2.28, w: 9.4, h: 0.32, fontSize: 13.5, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "LVEF ≤35% + LBBB + QRS ≥150 ms + NYHA class II–III (ambulatory IV) on GDMT — STRONGEST indication",
    "LVEF ≤35% + LBBB + QRS 120–149 ms — Class IIa recommendation",
    "LVEF ≤35% + non-LBBB + QRS ≥150 ms — Class IIb (less benefit)",
    "Patients requiring >40% ventricular pacing (RV pacing worsens HF)",
  ], { fontSize: 12 }), { x: 0.3, y: 2.65, w: 9.4, h: 1.2, valign: "top" });

  s.addText("CRT Benefits & CRT-D:", { x: 0.3, y: 3.98, w: 4.5, h: 0.32, fontSize: 13, bold: true, color: GREEN, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "↑ LVEF by 5–10%",
    "↓ NYHA class, improved QoL",
    "↓ HF hospitalisation",
    "↓ All-cause mortality (CARE-HF, COMPANION trials)",
    "CRT-D: combines CRT + ICD in one device",
  ], { fontSize: 12 }), { x: 0.3, y: 4.35, w: 4.5, h: 1.05, valign: "top" });

  s.addText("Non-Responders (~30%):", { x: 5.2, y: 3.98, w: 4.5, h: 0.32, fontSize: 13, bold: true, color: RED, fontFace: "Calibri", margin: 0 });
  s.addText(makeBullets([
    "Non-LBBB morphology, narrow QRS",
    "Advanced scar burden (ischaemic aetiology)",
    "Lead placement challenges",
    "Optimize GDMT before declaring non-response",
  ], { fontSize: 12 }), { x: 5.2, y: 4.35, w: 4.5, h: 1.05, valign: "top" });

  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 3.95, w: 0.04, h: 1.45, fill: { color: ACCENT } });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 21 – ADVANCED HF & TRANSPLANT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Advanced Heart Failure (Stage D)", "Refractory HF — Mechanical Support & Transplant");

  const options = [
    {
      title: "Inotropic Therapy",
      color: ACCENT,
      body: "IV dobutamine or milrinone as a bridge or palliative measure in Stage D. Continuous IV inotropes at home — palliative strategy. NOT a long-term solution.",
    },
    {
      title: "Ultrafiltration",
      color: ACCENT2,
      body: "Mechanical fluid removal for diuretic-resistant patients. CARRESS-HF trial: not superior to stepped diuretic therapy but useful in refractory cases.",
    },
    {
      title: "IABP (Intra-Aortic\nBalloon Pump)",
      color: YELLOW,
      body: "Counterpulsation device. Reduces afterload, improves coronary perfusion. Bridge to definitive therapy (LVAD or transplant). Limited by thrombosis risk.",
    },
    {
      title: "LVAD (Left Ventricular\nAssist Device)",
      color: GREEN,
      body: "Mechanical device that pumps blood from LV to aorta. Bridge to transplant (BTT) OR destination therapy (DT) in patients ineligible for transplant. Improves survival in Stage D.",
    },
    {
      title: "Cardiac Transplantation",
      color: RED,
      body: "Gold standard for Stage D HF. Indications: refractory HF (NYHA IV), peak VO2 <12 ml/kg/min. Contraindications: pulmonary HTN, active infection, malignancy, non-compliance.",
    },
    {
      title: "Palliative Care",
      color: MUTED,
      body: "Symptom control, patient/family support in end-stage HF. Hospice involvement, discontinue ICD shocks if requested. Shared decision-making is essential.",
    },
  ];

  options.forEach((o, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * 3.28;
    const y = 1.2 + row * 2.1;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.1, h: 1.95, fill: { color: CARD_BG }, line: { color: o.color, width: 1.3 }, rectRadius: 0.1 });
    s.addText(o.title, { x: x + 0.1, y: y + 0.08, w: 2.9, h: 0.42, fontSize: 12, bold: true, color: o.color, fontFace: "Calibri" });
    s.addText(o.body, { x: x + 0.12, y: y + 0.54, w: 2.88, h: 1.32, fontSize: 10.5, color: LIGHT_TXT, fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 22 – MONITORING & FOLLOW-UP
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Monitoring & Follow-Up", "Structured care to prevent decompensation");

  const monItems = [
    { label: "Daily Weight", detail: "Weigh every morning before eating. Gain >2 kg in 2 days = danger sign → increase diuretics or seek care" },
    { label: "Blood Pressure & HR", detail: "Target SBP 90–130 mmHg, HR 55–65 bpm. Hypotension: review diuretic/vasodilator doses" },
    { label: "Renal Function & Electrolytes", detail: "Check 1–2 weeks after starting/changing ACEi, ARNI, MRA. Monitor K+, creatinine. eGFR drop <30% acceptable" },
    { label: "BNP / NT-proBNP", detail: "Trend values. Persistently elevated BNP despite therapy = poor prognosis" },
    { label: "Echocardiogram", detail: "Repeat echo after 3–6 months of GDMT to reassess LVEF before ICD decision" },
    { label: "6-Minute Walk Test", detail: "Objective functional capacity. Distance <300m = poor prognosis" },
    { label: "Fluid & Salt Intake", detail: "Diary of fluid intake (<1.5–2 L/day in severe HF). Dietary counselling for sodium restriction" },
    { label: "Medication Compliance", detail: "Major cause of re-admission in India. Pill boxes, family education, simplify regimens. Avoid NSAIDs." },
  ];

  monItems.forEach((m, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 5.0;
    const y = 1.18 + row * 1.08;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.75, h: 1.0, fill: { color: CARD_BG }, line: { color: ACCENT, width: 0.8 }, rectRadius: 0.07 });
    s.addShape(pres.ShapeType.rect, { x, y, w: 1.6, h: 1.0, fill: { color: ACCENT + "22" } });
    s.addText(m.label, { x: x + 0.05, y, w: 1.5, h: 1.0, fontSize: 11, bold: true, color: ACCENT, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(m.detail, { x: x + 1.65, y: y + 0.06, w: 3.0, h: 0.88, fontSize: 11, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
  });

  s.addText("Clinic review: 2 weeks post-discharge, then 1–3 monthly in stable patients", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.2, fontSize: 10.5, color: MUTED, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 23 – DRUG SUMMARY TABLE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Drug Summary — HFrEF", "Quick reference for exam revision");

  const headers = ["Drug Class", "Agent", "Starting Dose", "Target Dose", "Mortality Benefit"];
  const rows = [
    ["ARNI", "Sacubitril-Valsartan", "24/26 mg BD", "97/103 mg BD", "YES (PARADIGM-HF)"],
    ["ACE Inhibitor", "Enalapril", "2.5 mg BD", "10–20 mg BD", "YES (CONSENSUS/SOLVD)"],
    ["ARB", "Candesartan", "4 mg OD", "32 mg OD", "Hospitalisations"],
    ["Beta-Blocker", "Bisoprolol", "1.25 mg OD", "10 mg OD", "YES (CIBIS-II)"],
    ["Beta-Blocker", "Carvedilol", "3.125 mg BD", "25–50 mg BD", "YES (COPERNICUS)"],
    ["MRA", "Spironolactone", "25 mg OD", "25–50 mg OD", "YES (RALES)"],
    ["MRA", "Eplerenone", "25 mg OD", "50 mg OD", "YES (EPHESUS)"],
    ["SGLT2i", "Dapagliflozin", "10 mg OD", "10 mg OD", "YES (DAPA-HF)"],
    ["Loop Diuretic", "Furosemide", "20–40 mg OD", "As needed", "Symptoms only"],
    ["If-channel", "Ivabradine", "5 mg BD", "7.5 mg BD", "Hospitalisations (SHIFT)"],
  ];

  const colWidths = [1.7, 1.9, 1.6, 1.6, 2.35];
  headers.forEach((h, ci) => {
    const x = 0.25 + colWidths.slice(0, ci).reduce((a, b) => a + b, 0);
    s.addShape(pres.ShapeType.rect, { x, y: 1.15, w: colWidths[ci], h: 0.38, fill: { color: ACCENT + "55" }, line: { color: ACCENT, width: 0.8 } });
    s.addText(h, { x: x + 0.05, y: 1.17, w: colWidths[ci] - 0.1, h: 0.34, fontSize: 11, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
  });

  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const x = 0.25 + colWidths.slice(0, ci).reduce((a, b) => a + b, 0);
      const y = 1.55 + ri * 0.39;
      const isMortality = ci === 4;
      const isYes = cell.startsWith("YES");
      s.addShape(pres.ShapeType.rect, {
        x, y, w: colWidths[ci], h: 0.38,
        fill: { color: ri % 2 === 0 ? CARD_BG : MID_BG },
        line: { color: MUTED + "44", width: 0.5 }
      });
      s.addText(cell, {
        x: x + 0.05, y: y + 0.04, w: colWidths[ci] - 0.1, h: 0.3,
        fontSize: 10.5,
        bold: isMortality && isYes,
        color: isMortality ? (isYes ? GREEN : YELLOW) : LIGHT_TXT,
        fontFace: "Calibri",
        align: ci >= 2 ? "center" : "left"
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 24 – KEY EXAM POINTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Key Exam Points for Final MBBS", "High-yield facts & common viva questions");

  const points = [
    { q: "Which drugs reduce mortality in HFrEF?", a: "ACEi/ARNI, Beta-blockers, MRA (spironolactone), SGLT2 inhibitors (DAPA-HF)" },
    { q: "PARADIGM-HF trial?", a: "Sacubitril-valsartan vs enalapril — 20% ↓ CV mortality; ↓ HF hospitalisation" },
    { q: "RALES trial?", a: "Spironolactone — 30% ↓ mortality in NYHA III–IV HF" },
    { q: "When NOT to start beta-blocker?", a: "Acute decompensated HF, bradycardia, hypotension, acute bronchospasm" },
    { q: "Ivabradine indication?", a: "Sinus rhythm, HR ≥70 bpm, LVEF ≤35%, NYHA II–IV on max beta-blocker" },
    { q: "CRT indication Class I?", a: "LVEF ≤35%, LBBB, QRS ≥150ms, NYHA II–III on GDMT" },
    { q: "ICD primary prevention?", a: "LVEF ≤35% despite ≥3 months GDMT, NYHA II–III, life expectancy >1 year" },
    { q: "HFpEF treatment?", a: "Diuretics for symptoms + treat comorbidities (HTN, AF, DM); SGLT2i show benefit" },
    { q: "Digoxin — DIG trial finding?", a: "↓ Hospitalisations; NO mortality benefit. Toxic in hypokalaemia" },
    { q: "Diuretic resistance management?", a: "Loop + thiazide combination (sequential blockade), IV loop diuretics, add SGLT2i" },
  ];

  points.forEach((p, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 5.0;
    const y = 1.18 + row * 0.86;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.75, h: 0.8, fill: { color: CARD_BG }, line: { color: i % 2 === 0 ? ACCENT : ACCENT2, width: 0.8 }, rectRadius: 0.07 });
    s.addText("Q: " + p.q, { x: x + 0.1, y: y + 0.04, w: 4.55, h: 0.28, fontSize: 10.5, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
    s.addText("A: " + p.a, { x: x + 0.1, y: y + 0.36, w: 4.55, h: 0.38, fontSize: 10.5, color: LIGHT_TXT, fontFace: "Calibri", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 25 – SUMMARY ALGORITHM
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  setContentBg(s);
  addHeaderBar(s, "Treatment Algorithm — HFrEF", "Step-wise approach: Newly diagnosed symptomatic HFrEF");

  const steps = [
    { step: "STEP 1", title: "Start ALL 4 pillars simultaneously or in rapid succession", color: ACCENT, detail: "ARNI (or ACEi/ARB) + Beta-blocker + MRA + SGLT2i — titrate to target doses over weeks to months" },
    { step: "STEP 2", title: "Diuretics for symptomatic congestion", color: ACCENT2, detail: "Furosemide / torasemide — titrate to dry weight. Reduce dose once euvolaemic. Not a long-term survival drug" },
    { step: "STEP 3", title: "Reassess LVEF after 3–6 months of GDMT", color: GREEN, detail: "If LVEF still ≤35% → consider ICD (primary prevention) and/or CRT if QRS ≥130–150ms with LBBB" },
    { step: "STEP 4", title: "Add Ivabradine if HR ≥70 bpm in sinus rhythm", color: YELLOW, detail: "NYHA II–IV, EF ≤35%, on maximally tolerated beta-blocker. NOT a substitute for beta-blocker" },
    { step: "STEP 5", title: "Refractory / Stage D", color: RED, detail: "Consider LVAD, cardiac transplant, continuous IV inotropes, palliative care. Multidisciplinary team decision" },
  ];

  steps.forEach((st, i) => {
    const y = 1.2 + i * 0.83;
    // connector arrow
    if (i < steps.length - 1) {
      s.addShape(pres.ShapeType.rect, { x: 0.72, y: y + 0.72, w: 0.06, h: 0.12, fill: { color: MUTED } });
    }
    s.addShape(pres.ShapeType.roundRect, { x: 0.25, y, w: 9.5, h: 0.78, fill: { color: CARD_BG }, line: { color: st.color, width: 1.3 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 1.05, h: 0.78, fill: { color: st.color + "44" } });
    s.addText(st.step, { x: 0.25, y, w: 1.05, h: 0.78, fontSize: 13, bold: true, color: st.color, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(st.title, { x: 1.4, y: y + 0.05, w: 8.1, h: 0.3, fontSize: 12.5, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });
    s.addText(st.detail, { x: 1.4, y: y + 0.38, w: 8.1, h: 0.32, fontSize: 10.5, color: LIGHT_TXT, fontFace: "Calibri", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 26 – THANK YOU
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: ACCENT } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.9, w: 10, h: 0.725, fill: { color: "091729" } });

  s.addText("THANK YOU", { x: 0.5, y: 1.2, w: 9, h: 0.9, fontSize: 50, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 2.18, w: 3, h: 0.06, fill: { color: ACCENT } });

  s.addText("Key References:", { x: 2, y: 2.45, w: 6, h: 0.35, fontSize: 13, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
  const refs = [
    "Braunwald's Heart Disease, 12th Edition",
    "Goldman-Cecil Medicine, International Edition",
    "Goodman & Gilman's Pharmacological Basis of Therapeutics",
    "ACC/AHA 2022 Guideline for HF Management",
    "PARADIGM-HF | DAPA-HF | RALES | CIBIS-II | MERIT-HF | COPERNICUS",
  ];
  s.addText(refs.map((r, i) => ({ text: r, options: { bullet: { code: "2022" }, color: LIGHT_TXT, fontSize: 11.5, fontFace: "Calibri", breakLine: i < refs.length - 1 } })),
    { x: 1.5, y: 2.88, w: 7, h: 1.7, valign: "top", align: "center" });

  s.addText("Prepared for Final Year MBBS | June 2026", {
    x: 0.5, y: 4.9, w: 9, h: 0.35, fontSize: 10, color: MUTED, fontFace: "Calibri", align: "center"
  });
}

// ── WRITE FILE ──────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/heart-failure-pptx/Treatment_Plan_Heart_Failure.pptx" })
  .then(() => console.log("SUCCESS: Presentation saved."))
  .catch(e => console.error("ERROR:", e));