mkdir -p /home/daytona/workspace/arrhythmia-pdf && ls /home/daytona/workspace/ar…

~/arrhythmia-pdf/generate_arrhythmia_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont

OUTPUT = "/home/daytona/workspace/arrhythmia-pdf/Arrhythmias_Short_Note_20Marks.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm, leftMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'TitleStyle',
    parent=styles['Title'],
    fontSize=20,
    textColor=colors.HexColor('#1a237e'),
    spaceAfter=4,
    alignment=TA_CENTER,
    fontName='Helvetica-Bold',
)
subtitle_style = ParagraphStyle(
    'SubtitleStyle',
    fontSize=11,
    textColor=colors.HexColor('#1565c0'),
    spaceAfter=2,
    alignment=TA_CENTER,
    fontName='Helvetica',
)
marks_style = ParagraphStyle(
    'MarksStyle',
    fontSize=10,
    textColor=colors.HexColor('#c62828'),
    spaceAfter=10,
    alignment=TA_CENTER,
    fontName='Helvetica-Bold',
)
section_style = ParagraphStyle(
    'SectionStyle',
    fontSize=13,
    textColor=colors.white,
    spaceBefore=10,
    spaceAfter=4,
    fontName='Helvetica-Bold',
    leftIndent=0,
    borderPad=6,
)
subheading_style = ParagraphStyle(
    'SubheadingStyle',
    fontSize=11,
    textColor=colors.HexColor('#1a237e'),
    spaceBefore=8,
    spaceAfter=3,
    fontName='Helvetica-Bold',
)
body_style = ParagraphStyle(
    'BodyStyle',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#212121'),
    spaceAfter=4,
    leading=15,
    alignment=TA_JUSTIFY,
    fontName='Helvetica',
)
bullet_style = ParagraphStyle(
    'BulletStyle',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#212121'),
    spaceAfter=3,
    leading=14,
    leftIndent=16,
    bulletIndent=4,
    fontName='Helvetica',
)
ref_style = ParagraphStyle(
    'RefStyle',
    fontSize=8,
    textColor=colors.HexColor('#546e7a'),
    spaceAfter=2,
    fontName='Helvetica-Oblique',
    alignment=TA_CENTER,
)

def section_header(text, color_hex='#1565c0'):
    data = [[Paragraph(text, ParagraphStyle(
        'sh', fontSize=13, textColor=colors.white,
        fontName='Helvetica-Bold', alignment=TA_LEFT, leading=16
    ))]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), colors.HexColor(color_hex)),
        ('TOPPADDING', (0,0), (-1,-1), 6),
        ('BOTTOMPADDING', (0,0), (-1,-1), 6),
        ('LEFTPADDING', (0,0), (-1,-1), 10),
        ('RIGHTPADDING', (0,0), (-1,-1), 10),
        ('ROUNDEDCORNERS', [4,4,4,4]),
    ]))
    return t

def colored_subhead(text):
    return Paragraph(f'<font color="#0d47a1"><b>{text}</b></font>', body_style)

def bullet(text):
    return Paragraph(f'&#8226; {text}', bullet_style)

def info_table(data, col_widths, header_color='#1565c0'):
    header = data[0]
    styled_header = [[Paragraph(f'<b>{c}</b>', ParagraphStyle(
        'th', fontSize=10, textColor=colors.white, fontName='Helvetica-Bold',
        alignment=TA_CENTER, leading=13
    )) for c in header]]
    styled_body = []
    for row in data[1:]:
        styled_body.append([Paragraph(str(c), ParagraphStyle(
            'td', fontSize=9.5, textColor=colors.HexColor('#212121'),
            fontName='Helvetica', leading=13
        )) for c in row])
    t = Table(styled_header + styled_body, colWidths=col_widths)
    style = [
        ('BACKGROUND', (0,0), (-1,0), colors.HexColor(header_color)),
        ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#b0bec5')),
        ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e3f2fd'), colors.white]),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
        ('TOPPADDING', (0,0), (-1,-1), 5),
        ('BOTTOMPADDING', (0,0), (-1,-1), 5),
        ('LEFTPADDING', (0,0), (-1,-1), 6),
        ('RIGHTPADDING', (0,0), (-1,-1), 6),
    ]
    t.setStyle(TableStyle(style))
    return t

story = []

# ─── TITLE BLOCK ────────────────────────────────────────────────────
story.append(Paragraph("CARDIAC ARRHYTHMIAS", title_style))
story.append(Paragraph("Causes · Investigations · Treatment", subtitle_style))
story.append(Paragraph("[Short Note — 20 Marks]", marks_style))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a237e'), spaceAfter=10))

# ─── INTRODUCTION ───────────────────────────────────────────────────
story.append(section_header("1. INTRODUCTION", '#1565c0'))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "A cardiac arrhythmia is any deviation from the normal sinus rhythm of the heart — an abnormality in the rate, "
    "regularity, or site of origin of the cardiac impulse, or a disturbance in conduction that causes an abnormal "
    "sequence of activation. Arrhythmias range from clinically insignificant to immediately life-threatening and "
    "represent a major cause of morbidity and mortality worldwide. They arise from disturbances in automaticity, "
    "triggered activity, or re-entry within the cardiac conduction system.",
    body_style
))

# ─── CLASSIFICATION ─────────────────────────────────────────────────
story.append(Spacer(1, 6))
story.append(section_header("2. CLASSIFICATION", '#1565c0'))
story.append(Spacer(1, 6))

cls_data = [
    ['Category', 'Examples'],
    ['Supraventricular (SVT)', 'Sinus tachycardia, AF, AFL, AVNRT, WPW syndrome'],
    ['Ventricular', 'PVCs, VT (monomorphic/polymorphic), VF, Torsades de pointes'],
    ['Bradyarrhythmias', 'Sinus bradycardia, SAN disease, AV block (1°, 2°, 3°)'],
    ['Channelopathies', 'Long QT syndrome, Brugada syndrome, Short QT syndrome'],
]
story.append(info_table(cls_data, [5.5*cm, 11.5*cm]))

# ─── CAUSES / AETIOLOGY ─────────────────────────────────────────────
story.append(Spacer(1, 8))
story.append(section_header("3. CAUSES / AETIOLOGY", '#0277bd'))
story.append(Spacer(1, 6))

story.append(colored_subhead("A. Cardiac Causes"))
cardiac_causes = [
    "Coronary artery disease (CAD) and acute myocardial infarction — most common cause of VT/VF",
    "Cardiomyopathies: dilated, hypertrophic (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC)",
    "Valvular heart disease (mitral stenosis, aortic stenosis) — predisposes to AF",
    "Congenital heart disease (ASD, VSD, Ebstein anomaly)",
    "Myocarditis and pericarditis — inflammation disrupts conduction",
    "Heart failure — elevated wall stress and neurohormonal activation promote arrhythmias",
    "Pre-excitation syndromes (Wolff-Parkinson-White syndrome)",
    "Cardiac surgery / catheterisation — direct mechanical injury to conduction tissue",
]
for c in cardiac_causes:
    story.append(bullet(c))

story.append(Spacer(1, 4))
story.append(colored_subhead("B. Metabolic and Electrolyte Disturbances"))
meta_causes = [
    "Hypokalaemia — increased automaticity and triggered activity (after-depolarisations); increased risk with digoxin",
    "Hyperkalaemia — depresses ectopic pacemakers; slows conduction; can cause fatal VF",
    "Hypomagnesaemia — precipitates Torsades de Pointes, refractory AF",
    "Hypocalcaemia — prolonged QT interval",
    "Hyperthyroidism — common reversible cause of AF; TSH should be checked at diagnosis",
    "Hypothyroidism — bradyarrhythmias and prolonged QT",
    "Acidosis and alkalosis — alter ion channel kinetics",
]
for c in meta_causes:
    story.append(bullet(c))

story.append(Spacer(1, 4))
story.append(colored_subhead("C. Drug-Induced (Proarrhythmia)"))
drug_causes = [
    "Class I antiarrhythmics (flecainide, quinidine) — proarrhythmia in structural heart disease",
    "Class III drugs (sotalol, amiodarone) — QT prolongation → Torsades de Pointes",
    "QT-prolonging agents: macrolides (erythromycin), fluoroquinolones, antipsychotics, TCAs, methadone",
    "Digoxin toxicity — PVCs, bigeminy, VT, AV block (especially with hypokalaemia)",
    "Sympathomimetics (adrenaline, cocaine, amphetamines) — catecholamine excess",
]
for c in drug_causes:
    story.append(bullet(c))

story.append(Spacer(1, 4))
story.append(colored_subhead("D. Autonomic and Systemic Causes"))
auto_causes = [
    "Increased sympathetic tone: anxiety, phaeochromocytoma, exercise, caffeine, alcohol",
    "Increased vagal tone: vasovagal syncope, carotid sinus hypersensitivity",
    "Obstructive sleep apnea — nocturnal AF, bradyarrhythmias",
    "Sepsis and critical illness — multifactorial arrhythmogenesis",
    "Pulmonary embolism — acute right heart strain, AF, sinus tachycardia",
    "Genetic syndromes: Long QT (LQTS), Brugada, CPVT, Short QT — channelopathies without structural disease",
]
for c in auto_causes:
    story.append(bullet(c))

# ─── INVESTIGATIONS ──────────────────────────────────────────────────
story.append(Spacer(1, 8))
story.append(section_header("4. INVESTIGATIONS", '#2e7d32'))
story.append(Spacer(1, 6))

story.append(colored_subhead("A. Electrocardiography (ECG) — First-line and Most Important"))
ecg_points = [
    "12-lead ECG: identifies arrhythmia type, heart rate, axis, PR/QRS/QT intervals, delta waves (WPW), ST changes",
    "Q waves → prior silent MI; ventricular hypertrophy; Brugada pattern (coved ST elevation V1-V2)",
    "Long QT syndrome: QTc >450 ms (men), >470 ms (women); risk of Torsades de Pointes",
    "During sinus rhythm: PVCs, bundle branch block, pre-excitation may be visible",
    "Ambulatory ECG (Holter Monitor, 24–48 h): documents intermittent arrhythmias correlated with symptoms",
    "Event recorder / implantable loop recorder (ILR): for infrequent, unexplained syncope over months to years",
    "Exercise stress test (EST): reveals exercise-induced VT, CPVT; assesses rate response",
]
for p in ecg_points:
    story.append(bullet(p))

story.append(Spacer(1, 4))
story.append(colored_subhead("B. Laboratory Investigations"))
lab_data = [
    ['Test', 'Rationale / What to Look For'],
    ['Serum electrolytes (K⁺, Na⁺, Mg²⁺, Ca²⁺)', 'Electrolyte imbalance as precipitant or perpetuator'],
    ['Thyroid function tests (TSH, T3, T4)', 'Hyper-/hypothyroidism — reversible cause of AF'],
    ['Full blood count (FBC)', 'Anaemia → compensatory tachycardia'],
    ['Cardiac biomarkers (Troponin I/T, CK-MB)', 'Acute MI or myocarditis as substrate'],
    ['Renal function (urea, creatinine)', 'Renal failure → hyperkalaemia, drug accumulation'],
    ['Liver function tests (LFTs)', 'Liver disease → reduced drug metabolism (amiodarone)'],
    ['Drug levels', 'Digoxin toxicity; therapeutic monitoring of antiarrhythmics'],
    ['Arterial Blood Gas (ABG)', 'Acidosis/alkalosis in critically ill patients'],
    ['BNP / NT-proBNP', 'Heart failure assessment; elevated in structural heart disease'],
]
story.append(info_table(lab_data, [7*cm, 10*cm], '#2e7d32'))

story.append(Spacer(1, 6))
story.append(colored_subhead("C. Cardiac Imaging"))
imaging_points = [
    "Transthoracic Echocardiography (TTE): LV/RV function (EF), wall motion, hypertrophy, valvular disease, pericardial effusion — most common initial imaging",
    "Cardiac MRI with gadolinium: detects myocardial scar (late gadolinium enhancement) — key in VT workup; identifies ARVC, myocarditis, HCM",
    "Coronary angiography / CT coronary angiography: excludes obstructive CAD as arrhythmia substrate",
    "Nuclear imaging (MIBG scan): sympathetic innervation mapping in HF-related arrhythmias",
]
for p in imaging_points:
    story.append(bullet(p))

story.append(Spacer(1, 4))
story.append(colored_subhead("D. Electrophysiological Study (EPS)"))
eps_points = [
    "Invasive intracardiac study — maps conduction system, induces and localises arrhythmia circuit",
    "Indications: risk stratification in VT/VF survivors, unexplained syncope, ablation planning, WPW",
    "Programmed electrical stimulation (PES): triggers VT in patients with scar-mediated re-entry",
    "Head-up tilt table test: diagnoses vasovagal syncope and POTS",
]
for p in eps_points:
    story.append(bullet(p))

# ─── TREATMENT ───────────────────────────────────────────────────────
story.append(Spacer(1, 8))
story.append(section_header("5. TREATMENT OF ARRHYTHMIAS", '#6a1b9a'))
story.append(Spacer(1, 6))

story.append(Paragraph(
    "Treatment is guided by: (1) type of arrhythmia (tachy vs brady, SVT vs VT), "
    "(2) haemodynamic stability, (3) presence of structural heart disease, "
    "(4) symptom burden, and (5) risk of sudden cardiac death. "
    "The mere detection of an arrhythmia does not automatically mandate pharmacologic suppression.",
    body_style
))
story.append(Spacer(1, 4))

story.append(colored_subhead("A. General / Conservative Measures"))
gen_tx = [
    "Treat the underlying cause: correct electrolytes, manage ischaemia, treat thyroid disease, control infection",
    "Avoid precipitants: limit caffeine, alcohol, sympathomimetic drugs, QT-prolonging agents",
    "Reassurance and lifestyle modification for benign, structurally normal-heart arrhythmias",
]
for t in gen_tx:
    story.append(bullet(t))

story.append(Spacer(1, 4))
story.append(colored_subhead("B. Pharmacological Treatment — Vaughan Williams Classification"))
story.append(Spacer(1, 3))

drug_data = [
    ['Class', 'Mechanism', 'Key Drugs', 'Clinical Use'],
    ['Ia', 'Na⁺ block + K⁺ block\n(moderate use-dependent)', 'Quinidine, Procainamide,\nDisopyramide', 'AF, VT (limited — proarrhythmic)'],
    ['Ib', 'Na⁺ block\n(fast-dissociation)', 'Lignocaine (IV),\nMexiletine', 'Acute VT/VF (lignocaine IV);\nVentricular arrhythmias'],
    ['Ic', 'Na⁺ block\n(slow-dissociation)', 'Flecainide,\nPropafenone', 'AF/AFL in structurally\nnormal hearts; AVNRT'],
    ['II', 'β-adrenergic blockade\n(sympatholytic)', 'Metoprolol, Atenolol,\nCarvedilol, Propranolol', '1st-line: most VAs, AF rate\ncontrol, exercise-induced VT'],
    ['III', 'K⁺ channel block\n(prolongs repolarisation)', 'Amiodarone, Sotalol,\nDofetilide, Ibutilide', 'VT/VF, AF/AFL rhythm\ncontrol; drug of choice in\nstructural heart disease'],
    ['IV', 'Ca²⁺ channel block\n(non-DHP)', 'Verapamil,\nDiltiazem', 'AF/AFL rate control;\nAVNRT; idiopathic VT\n(verapamil-sensitive)'],
    ['V', 'Other / Multiple', 'Digoxin, Adenosine,\nMagnesium', 'AF rate control (HF);\nSVT termination;\nTorsades de Pointes'],
]
story.append(info_table(drug_data, [1.7*cm, 4*cm, 4.2*cm, 7.1*cm], '#6a1b9a'))

story.append(Spacer(1, 6))
story.append(colored_subhead("C. Special Treatment Scenarios"))
story.append(Spacer(1, 3))

scenario_data = [
    ['Arrhythmia', 'Acute Management', 'Long-term Strategy'],
    ['Haemodynamically\nunstable SVT/VT/VF', 'Immediate DC cardioversion\n(synchronised/unsynchronised)', 'ICD ± antiarrhythmic drug;\ncatheter ablation'],
    ['Stable SVT (AVNRT)', 'Vagal manoeuvres → IV adenosine\n(6 mg, repeat 12 mg)', 'Ablation (curative); CCB or\nβ-blocker for prevention'],
    ['Atrial Fibrillation', 'Rate control: BB/CCB/digoxin;\nDC cardioversion if haemodynamic compromise;\nanticoagulation (NOAC/warfarin)', 'Rate vs rhythm control;\nablation (PV isolation);\nstroke prevention essential'],
    ['Ventricular Tachycardia\n(stable, structural heart disease)', 'IV amiodarone (300 mg over 20–60 min);\nor IV lignocaine', 'ICD implantation;\ncatheter ablation;\namiodarone or sotalol'],
    ['Torsades de Pointes', 'IV Magnesium sulphate 2 g over 5 min;\ntemporary pacing to increase rate;\nstop QT-prolonging drugs', 'Correct underlying cause;\nICD if recurrent'],
    ['Bradyarrhythmia\n(symptomatic)', 'Atropine 0.5–1 mg IV;\nor Isoprenaline infusion', 'Permanent pacemaker (PPM)\nimplantation'],
    ['Complete Heart Block\n(3° AV block)', 'Temporary transvenous pacing', 'Permanent pacemaker'],
]
story.append(info_table(scenario_data, [3.8*cm, 6.1*cm, 7.1*cm], '#6a1b9a'))

story.append(Spacer(1, 6))
story.append(colored_subhead("D. Non-Pharmacological / Interventional Treatments"))
nonpharm = [
    "DC Cardioversion: synchronised (VT/SVT) or unsynchronised defibrillation (VF/pulseless VT) — first line for haemodynamic instability",
    "Catheter Ablation: radiofrequency (RF) or cryoablation to destroy arrhythmia focus or re-entry circuit. Curative for AVNRT (>95%), AF (PV isolation 60–80%), accessory pathways (WPW), idiopathic VT",
    "Implantable Cardioverter-Defibrillator (ICD): primary or secondary prevention of sudden cardiac death in VT/VF; detects and terminates life-threatening arrhythmia automatically",
    "Cardiac Resynchronisation Therapy (CRT): biventricular pacing in HF with LBBB (QRS >150 ms, EF <35%) — reduces arrhythmic burden",
    "Permanent Pacemaker (PPM): indicated for symptomatic bradyarrhythmias, SAN disease, 2°/3° AV block — single/dual/rate-responsive chamber devices",
    "Surgical ablation (Cox-Maze procedure): for AF during concomitant cardiac surgery",
    "Left cardiac sympathetic denervation (LCSD): for refractory LQTS, CPVT, or VT storm",
]
for n in nonpharm:
    story.append(bullet(n))

# ─── IMPORTANT NOTES ─────────────────────────────────────────────────
story.append(Spacer(1, 8))
story.append(section_header("6. KEY CLINICAL POINTS FOR EXAMS", '#e65100'))
story.append(Spacer(1, 6))

key_data = [
    ['Point', 'Detail'],
    ['Proarrhythmia risk', 'All antiarrhythmic drugs can CAUSE arrhythmias (proarrhythmia). Risk is highest in patients with structural heart disease (Class Ic drugs contraindicated post-MI)'],
    ['CAST Trial', 'Cardiac Arrhythmia Suppression Trial — showed increased mortality with flecainide/encainide post-MI despite PVC suppression. Established "treat the patient, not the rhythm" principle'],
    ['Rate vs Rhythm control', 'In AF, rate control (BB/CCB) shown equivalent or superior to rhythm control in AFFIRM trial for most patients. Anticoagulation for stroke prevention is mandatory regardless of strategy'],
    ['ICD superiority', 'ICD is superior to antiarrhythmic drugs (including amiodarone) for secondary prevention of cardiac arrest (AVID, CIDS, CASH trials)'],
    ['Amiodarone toxicity', 'Pulmonary toxicity, thyroid dysfunction (hypo/hyperthyroidism), corneal microdeposits, hepatotoxicity, photosensitivity, peripheral neuropathy — multiple organ monitoring required'],
    ['Adenosine', 'Half-life 10 seconds — terminates most SVTs. Contraindicated in asthma; can reveal underlying atrial flutter/fibrillation'],
]
story.append(info_table(key_data, [4.5*cm, 12.5*cm], '#e65100'))

# ─── SUMMARY TABLE ────────────────────────────────────────────────────
story.append(Spacer(1, 8))
story.append(section_header("7. SUMMARY", '#37474f'))
story.append(Spacer(1, 6))
story.append(Paragraph(
    "Arrhythmias result from disturbances in automaticity, triggered activity, or re-entry. "
    "Common causes include ischaemic heart disease, electrolyte imbalance, drug toxicity, and channelopathies. "
    "Investigation centres on the 12-lead ECG, ambulatory monitoring, echocardiography, and selective EPS. "
    "Treatment follows a stepwise approach: correct the reversible cause, use antiarrhythmic drugs (Vaughan Williams I-V) appropriately, "
    "and deploy device therapy (ICD, PPM, CRT) or catheter ablation for definitive management. "
    "The overarching goal is to reduce symptoms and prevent sudden cardiac death while minimising proarrhythmic risk.",
    body_style
))

# ─── REFERENCES ──────────────────────────────────────────────────────
story.append(Spacer(1, 10))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#90a4ae'), spaceAfter=4))
story.append(Paragraph("References", ParagraphStyle('ref_hd', fontSize=9, fontName='Helvetica-Bold', textColor=colors.HexColor('#546e7a'))))
refs = [
    "Harrison's Principles of Internal Medicine, 22nd Edition (2025), Chapter 259 — Approach to the Patient with Arrhythmias",
    "Katzung's Basic and Clinical Pharmacology, 16th Edition — Chapter 14: Antiarrhythmic Drugs",
    "Goodman & Gilman's The Pharmacological Basis of Therapeutics — Antiarrhythmic Drugs",
    "Braunwald's Heart Disease, A Textbook of Cardiovascular Medicine",
    "Goldman-Cecil Medicine, International Edition — Ventricular Arrhythmias",
]
for r in refs:
    story.append(Paragraph(f"• {r}", ref_style))

doc.build(story)
print(f"PDF generated: {OUTPUT}")

cd /home/daytona/workspace/arrhythmia-pdf && python generate_arrhythmia_pdf.py

ls -lh /home/daytona/workspace/arrhythmia-pdf/