ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace/ecg-…

mkdir -p /home/daytona/workspace/ecg-cases && ls /home/daytona/workspace/ecg-cas…

~/ecg-cases/generate_ecgs.py

#!/usr/bin/env python3
"""
Generate 10 ECG cases with text/grid representation and diagnoses.
Uses matplotlib to render ASCII-style ECG waveforms on a grid background.
"""

import matplotlib
matplotlib.use('Agg')
import matplotlib.pyplot as plt
import matplotlib.patches as mpatches
import numpy as np
from matplotlib.gridspec import GridSpec
import os

OUT_DIR = "/home/daytona/workspace/ecg-cases/output"
os.makedirs(OUT_DIR, exist_ok=True)

# ── helpers ──────────────────────────────────────────────────────────────────

def draw_grid(ax, x_max, y_min=-2.5, y_max=2.5):
    """Draw standard ECG grid (large = 5 mm, small = 1 mm)."""
    ax.set_facecolor('#fff8f0')
    # minor 1 mm
    ax.set_xticks(np.arange(0, x_max, 0.04), minor=True)
    ax.set_yticks(np.arange(y_min, y_max, 0.1), minor=True)
    # major 5 mm
    ax.set_xticks(np.arange(0, x_max, 0.2))
    ax.set_yticks(np.arange(y_min, y_max, 0.5))
    ax.grid(which='major', color='#e09090', linewidth=0.8, linestyle='-')
    ax.grid(which='minor', color='#f0c0c0', linewidth=0.3, linestyle='-')
    ax.tick_params(labelbottom=False, labelleft=False, length=0)
    ax.set_xlim(0, x_max)
    ax.set_ylim(y_min, y_max)

def plot_ecg(ax, signal, fs=250):
    """Plot a single ECG lead."""
    t = np.arange(len(signal)) / fs
    ax.plot(t, signal, color='black', linewidth=1.0)

# ── waveform generators ───────────────────────────────────────────────────────

def gaussian(x, mu, sigma, amp):
    return amp * np.exp(-0.5 * ((x - mu) / sigma) ** 2)

def normal_beat(t_offset=0, hr=72, baseline=0):
    """Return one normal sinus beat array at 250 Hz."""
    fs = 250
    rr = 60 / hr
    n = int(rr * fs)
    t = np.linspace(0, rr, n)
    sig = np.zeros(n)
    # P wave
    sig += gaussian(t, 0.10, 0.025, 0.15)
    # QRS
    sig += gaussian(t, 0.22, 0.008, -0.1)   # Q
    sig += gaussian(t, 0.24, 0.010, 1.5)    # R
    sig += gaussian(t, 0.26, 0.008, -0.15)  # S
    # T wave
    sig += gaussian(t, 0.38, 0.040, 0.35)
    return sig + baseline

def make_repeating(beat_fn, n_beats, **kwargs):
    return np.concatenate([beat_fn(**kwargs) for _ in range(n_beats)])

# ── 10 ECG cases ─────────────────────────────────────────────────────────────

CASES = []

# ─── Case 1: Normal Sinus Rhythm ─────────────────────────────────────────────
def case1():
    fs = 250
    beats = []
    for _ in range(6):
        beats.append(normal_beat(hr=72))
    return np.concatenate(beats)

CASES.append({
    "title": "Case 1 — 45-year-old male, routine checkup",
    "vitals": "HR 72 bpm | BP 120/80 | No symptoms",
    "signal": case1(),
    "lead": "Lead II",
    "diagnosis": "NORMAL SINUS RHYTHM",
    "findings": [
        "Rate: 72 bpm (regular)",
        "P waves: upright, precede every QRS, uniform morphology",
        "PR interval: 160 ms (normal 120–200 ms)",
        "QRS duration: 80 ms (narrow, normal <120 ms)",
        "QT interval: 380 ms (normal)",
        "ST segment: isoelectric",
        "T waves: upright, concordant",
    ],
    "teaching": (
        "Normal sinus rhythm requires: rate 60–100 bpm, P before every QRS, "
        "regular P-P and R-R intervals, PR 120–200 ms, QRS <120 ms. "
        "All criteria are met here."
    ),
})

# ─── Case 2: Atrial Fibrillation ─────────────────────────────────────────────
def case2():
    fs = 250
    rng = np.random.default_rng(42)
    sig = []
    t = 0
    while t < 2500:
        rr_var = int(rng.integers(150, 350))   # irregularly irregular
        beat_t = np.linspace(0, rr_var / fs, rr_var)
        beat = np.zeros(rr_var)
        # fibrillatory baseline
        for f in [4, 6, 8, 10, 12]:
            beat += rng.uniform(0.02, 0.06) * np.sin(
                2 * np.pi * f * beat_t + rng.uniform(0, 2 * np.pi))
        # QRS (no P wave)
        mid = rr_var // 2
        beat += gaussian(beat_t, beat_t[mid - 8], 0.010, -0.08)
        beat += gaussian(beat_t, beat_t[mid],     0.010, 1.4)
        beat += gaussian(beat_t, beat_t[mid + 8], 0.010, -0.12)
        # T wave
        beat += gaussian(beat_t, beat_t[mid] + 0.14, 0.040, 0.28)
        sig.append(beat)
        t += rr_var
    return np.concatenate(sig)[:2500]

CASES.append({
    "title": "Case 2 — 68-year-old male, palpitations × 3 hours",
    "vitals": "HR ~110 bpm (irregular) | BP 135/88 | SpO₂ 97%",
    "signal": case2(),
    "lead": "Lead II",
    "diagnosis": "ATRIAL FIBRILLATION (uncontrolled ventricular rate)",
    "findings": [
        "Rate: 100–130 bpm (irregularly irregular)",
        "No discernible P waves — replaced by fibrillatory (f) waves",
        "R-R intervals: variable (hallmark of AF)",
        "QRS: narrow (<120 ms) — normal ventricular conduction",
        "ST segment: no significant deviation",
    ],
    "teaching": (
        "AF key criteria: absent P waves, irregularly irregular rhythm, "
        "narrow QRS (unless aberrant conduction/WPW). "
        "Rate control target <110 bpm at rest. Always assess CHA₂DS₂-VASc for anticoagulation."
    ),
})

# ─── Case 3: ST-Elevation MI (Inferior) ──────────────────────────────────────
def case3():
    fs = 250
    beats = []
    for _ in range(5):
        n = int(250 * (60 / 88))
        t = np.linspace(0, 60/88, n)
        sig = np.zeros(n)
        sig += gaussian(t, 0.10, 0.025, 0.14)   # P
        sig += gaussian(t, 0.22, 0.008, -0.08)  # Q (deep in inferior)
        sig += gaussian(t, 0.24, 0.010, 1.3)    # R
        sig += gaussian(t, 0.26, 0.008, -0.1)   # S
        # ST elevation 2 mm + hyperacute T
        sig += 0.2 * (t > 0.27) * (t < 0.50) * np.exp(-8*(t - 0.37))
        sig += gaussian(t, 0.44, 0.045, 0.65)   # hyperacute T
        beats.append(sig)
    return np.concatenate(beats)

CASES.append({
    "title": "Case 3 — 58-year-old male, crushing chest pain × 45 min",
    "vitals": "HR 88 bpm | BP 100/65 | Diaphoretic",
    "signal": case3(),
    "lead": "Lead II (inferior leads II, III, aVF affected)",
    "diagnosis": "INFERIOR STEMI — Right Coronary Artery (RCA) occlusion",
    "findings": [
        "ST elevation ≥2 mm in II, III, aVF",
        "Reciprocal ST depression in I, aVL",
        "Hyperacute (tall, peaked) T waves",
        "Q waves beginning to form (early infarct)",
        "HR 88 bpm, sinus rhythm",
    ],
    "teaching": (
        "Inferior STEMI: ST↑ in II, III, aVF with reciprocal changes in I/aVL. "
        "RCA supplies inferior wall in 85% of patients. "
        "Always check right-sided leads (V3R, V4R) for RV infarct. "
        "Door-to-balloon time <90 min. Avoid nitrates if RV involvement."
    ),
})

# ─── Case 4: Complete Heart Block (3rd Degree AV Block) ──────────────────────
def case4():
    fs = 250
    duration = 2500
    sig = np.zeros(duration)
    t = np.arange(duration) / fs
    # P waves at 75 bpm (atrial rate) — marching through
    p_interval = int(fs * 60 / 75)
    for p in range(0, duration, p_interval):
        for i, pt in enumerate(t):
            idx = int(p + i)
            if idx < duration:
                sig[idx] += gaussian(np.array([t[min(idx, duration-1)]]),
                                     t[p] + 0.10, 0.025, 0.14)[0]
    # Escape QRS at 38 bpm (junctional escape) — wide
    qrs_interval = int(fs * 60 / 38)
    for q in range(int(qrs_interval * 0.3), duration, qrs_interval):
        bt = np.linspace(0, 0.6, int(0.6 * fs))
        beat = np.zeros(int(0.6 * fs))
        beat += gaussian(bt, 0.20, 0.025, -0.15)
        beat += gaussian(bt, 0.25, 0.018, 1.2)
        beat += gaussian(bt, 0.30, 0.018, -0.25)
        beat += gaussian(bt, 0.45, 0.060, 0.4)  # wide T
        end = min(q + len(beat), duration)
        sig[q:end] += beat[:end - q]
    return sig

CASES.append({
    "title": "Case 4 — 72-year-old female, syncope, near-fall",
    "vitals": "HR 38 bpm | BP 88/55 | Pale",
    "signal": case4(),
    "lead": "Lead II",
    "diagnosis": "COMPLETE (3rd DEGREE) AV BLOCK with junctional escape",
    "findings": [
        "Atrial rate: 75 bpm (regular P waves)",
        "Ventricular rate: 38 bpm (regular but independent)",
        "AV dissociation: P waves and QRS march independently",
        "QRS: wide (~140 ms) — ventricular escape rhythm",
        "No relationship between P waves and QRS (PR interval varies)",
    ],
    "teaching": (
        "3rd degree AV block: complete failure of AV conduction. "
        "Atria and ventricles beat independently. "
        "Escape rhythm source determines QRS width: junctional (narrow) vs ventricular (wide). "
        "Immediate transcutaneous pacing, then permanent pacemaker. "
        "Causes: inferior MI (RCA), Lyme disease, medication toxicity (digoxin, beta-blockers)."
    ),
})

# ─── Case 5: Ventricular Tachycardia ─────────────────────────────────────────
def case5():
    fs = 250
    duration = 2500
    t = np.arange(duration) / fs
    sig = np.zeros(duration)
    vt_rate = 160
    vt_interval = fs * 60 // vt_rate
    for q in range(0, duration, vt_interval):
        bt = np.linspace(0, 0.4, int(0.4 * fs))
        beat = np.zeros(int(0.4 * fs))
        beat += gaussian(bt, 0.08, 0.030, -0.3)   # broad initial deflection
        beat += gaussian(bt, 0.16, 0.030, 1.6)    # tall R
        beat += gaussian(bt, 0.24, 0.030, -0.5)   # broad S
        beat += gaussian(bt, 0.33, 0.040, -0.4)   # discordant T
        end = min(q + len(beat), duration)
        sig[q:end] += beat[:end - q]
    return sig

CASES.append({
    "title": "Case 5 — 55-year-old male, sudden palpitations, presyncope",
    "vitals": "HR 160 bpm (regular) | BP 85/50 | Diaphoretic",
    "signal": case5(),
    "lead": "Lead II",
    "diagnosis": "VENTRICULAR TACHYCARDIA (monomorphic)",
    "findings": [
        "Rate: 160 bpm, regular",
        "QRS: wide (>140 ms), bizarre morphology",
        "No visible P waves (buried or absent)",
        "AV dissociation (if P waves visible, march independently)",
        "Concordance across precordial leads (positive)",
        "Northwest axis deviation",
    ],
    "teaching": (
        "VT criteria (Brugada algorithm): absence of RS in precordial leads, "
        "RS interval >100 ms, AV dissociation, morphology criteria (LBBB/RBBB pattern). "
        "Wide complex tachycardia = VT until proven otherwise. "
        "Hemodynamically unstable: immediate synchronized cardioversion. "
        "Stable: amiodarone 150 mg IV. Check K⁺, Mg²⁺, ischemia."
    ),
})

# ─── Case 6: Wolff-Parkinson-White (WPW) ─────────────────────────────────────
def case6():
    fs = 250
    beats = []
    for _ in range(5):
        n = int(fs * 60 / 78)
        t = np.linspace(0, 60/78, n)
        sig = np.zeros(n)
        sig += gaussian(t, 0.10, 0.022, 0.14)   # P wave
        # Delta wave (slurred upstroke) + short PR
        delta_start = 0.17
        sig += 0.3 * np.clip((t - delta_start) / 0.025, 0, 1) * \
               np.exp(-4 * np.maximum(t - delta_start - 0.030, 0))
        sig += gaussian(t, 0.215, 0.010, 1.3)   # R
        sig += gaussian(t, 0.240, 0.010, -0.25) # S
        sig += gaussian(t, 0.37,  0.040, -0.30) # discordant T (negative)
        beats.append(sig)
    return np.concatenate(beats)

CASES.append({
    "title": "Case 6 — 28-year-old female, episodic palpitations since teens",
    "vitals": "HR 78 bpm | BP 118/76 | Currently asymptomatic",
    "signal": case6(),
    "lead": "Lead II",
    "diagnosis": "WOLFF-PARKINSON-WHITE SYNDROME (WPW)",
    "findings": [
        "Short PR interval: <120 ms",
        "Delta wave: slurred upstroke of QRS (pre-excitation)",
        "Wide QRS: >120 ms (from delta wave contribution)",
        "ST-T changes: secondary, discordant to delta/QRS",
        "Tachyarrhythmia history: AVRT (SVT via accessory pathway)",
    ],
    "teaching": (
        "WPW triad: short PR + delta wave + wide QRS. "
        "Accessory pathway (Bundle of Kent) bypasses AV node → ventricular pre-excitation. "
        "Risk: AF with rapid ventricular response (can degenerate to VF — AVOID AV nodal blockers). "
        "Definitive treatment: radiofrequency catheter ablation."
    ),
})

# ─── Case 7: Hyperkalemia ────────────────────────────────────────────────────
def case7():
    fs = 250
    beats = []
    for _ in range(5):
        n = int(fs * 60 / 60)
        t = np.linspace(0, 1.0, n)
        sig = np.zeros(n)
        # Flattened P wave
        sig += gaussian(t, 0.10, 0.040, 0.06)
        # QRS widened
        sig += gaussian(t, 0.22, 0.012, -0.08)
        sig += gaussian(t, 0.25, 0.018, 1.2)
        sig += gaussian(t, 0.28, 0.012, -0.15)
        # TALL peaked T wave (tent-shaped)
        sig += gaussian(t, 0.42, 0.025, 0.90)
        beats.append(sig)
    return np.concatenate(beats)

CASES.append({
    "title": "Case 7 — 65-year-old male, CKD stage 4, weakness",
    "vitals": "HR 60 bpm | BP 155/95 | K⁺ = 7.1 mEq/L",
    "signal": case7(),
    "lead": "Lead II / V5",
    "diagnosis": "HYPERKALEMIA (severe, K⁺ ≈ 7.1 mEq/L)",
    "findings": [
        "Tall, narrow, peaked (tent-shaped) T waves — earliest sign",
        "Flattened/absent P waves (severe hyperkalemia)",
        "PR interval prolongation",
        "QRS widening (>100 ms) — sine-wave pattern if worsens",
        "Sinus rate 60 bpm",
    ],
    "teaching": (
        "Hyperkalemia ECG progression: peaked T → flat P → wide QRS → sine wave → VF. "
        "Immediate management: "
        "(1) Ca²⁺ gluconate 1 g IV (membrane stabilization within 1–3 min), "
        "(2) Insulin 10 U + dextrose (shift K⁺ into cells), "
        "(3) Sodium bicarbonate (if acidosis), "
        "(4) Kayexalate/patiromer/SZC (excretion), "
        "(5) Dialysis if refractory."
    ),
})

# ─── Case 8: Left Bundle Branch Block (LBBB) ─────────────────────────────────
def case8():
    fs = 250
    beats = []
    for _ in range(5):
        n = int(fs * 60 / 70)
        t = np.linspace(0, 60/70, n)
        sig = np.zeros(n)
        sig += gaussian(t, 0.10, 0.025, 0.14)    # P
        # Wide notched R in V5/V6 pattern (LBBB)
        sig += gaussian(t, 0.21, 0.010, -0.05)   # no Q (absent septal Q)
        sig += gaussian(t, 0.26, 0.022, 0.9)     # broad R peak 1
        sig += gaussian(t, 0.31, 0.022, 1.1)     # broad R peak 2 (notch)
        sig += gaussian(t, 0.36, 0.015, -0.3)    # S descent
        # Discordant T wave (opposite to QRS)
        sig += gaussian(t, 0.52, 0.045, -0.45)
        beats.append(sig)
    return np.concatenate(beats)

CASES.append({
    "title": "Case 8 — 62-year-old female, dyspnea on exertion",
    "vitals": "HR 70 bpm | BP 142/88 | History of HTN, no chest pain",
    "signal": case8(),
    "lead": "Lead V5 (lateral)",
    "diagnosis": "LEFT BUNDLE BRANCH BLOCK (LBBB) — New onset",
    "findings": [
        "QRS duration: ≥120 ms (broad)",
        "Broad, notched (M-shaped) R wave in lateral leads (I, aVL, V5–V6)",
        "Absent septal Q waves in I, V5, V6",
        "ST and T wave changes: discordant (opposite to QRS direction)",
        "Left axis deviation",
    ],
    "teaching": (
        "LBBB criteria (Sgarbossa if STEMI suspected): QRS ≥120 ms, broad notched R in V5/V6, "
        "no septal Q in I/V5/V6, discordant ST-T. "
        "NEW LBBB = STEMI equivalent until proven otherwise (activates cath lab). "
        "Old LBBB: look for concordant ST elevation ≥1 mm or "
        "ST elevation ≥5 mm discordant (Sgarbossa criteria)."
    ),
})

# ─── Case 9: Pulmonary Embolism ───────────────────────────────────────────────
def case9():
    """S1Q3T3 pattern + sinus tachycardia + RBBB features."""
    fs = 250
    beats = []
    for _ in range(6):
        n = int(fs * 60 / 105)
        t = np.linspace(0, 60/105, n)
        sig = np.zeros(n)
        sig += gaussian(t, 0.08, 0.020, 0.13)   # P
        # S1: deep S in lead I (shown here)
        sig += gaussian(t, 0.19, 0.009, -0.06)  # Q
        sig += gaussian(t, 0.21, 0.010, 1.1)    # R
        sig += gaussian(t, 0.24, 0.012, -0.45)  # deep S (S1 pattern)
        # RBBB pattern: rSR' (terminal R')
        sig += gaussian(t, 0.29, 0.012, 0.35)   # R' (terminal conduction delay)
        # T wave inversion (Q3T3 — lead III equivalent)
        sig += gaussian(t, 0.40, 0.035, -0.28)  # T inversion
        beats.append(sig)
    return np.concatenate(beats)

CASES.append({
    "title": "Case 9 — 38-year-old female, acute dyspnea, pleuritic chest pain",
    "vitals": "HR 105 bpm | BP 105/70 | SpO₂ 91% | Recent long-haul flight",
    "signal": case9(),
    "lead": "Lead I / III composite (S₁Q₃T₃ pattern shown)",
    "diagnosis": "PULMONARY EMBOLISM (massive/submassive)",
    "findings": [
        "Sinus tachycardia: 105 bpm",
        "S1Q3T3 pattern: deep S in I, Q wave + T inversion in III",
        "Incomplete RBBB (rSR' in V1, wide S in V6)",
        "T wave inversions V1–V4 (RV strain)",
        "Right axis deviation",
    ],
    "teaching": (
        "PE ECG findings (none are specific or sensitive): sinus tachycardia (most common), "
        "S1Q3T3, RBBB, T inversions V1–V4, right axis deviation. "
        "ECG normal in ~40% of PE. Diagnose with CT-PA (preferred) or V/Q scan. "
        "Massive PE (hemodynamic instability): systemic thrombolysis or embolectomy. "
        "Submassive: anticoagulation ± catheter-directed thrombolysis."
    ),
})

# ─── Case 10: Torsades de Pointes (TdP) ──────────────────────────────────────
def case10():
    fs = 250
    rng = np.random.default_rng(7)
    duration = 2500
    sig = np.zeros(duration)
    # Preceding long QT beat
    for q_start in [0, 280]:
        bt = np.linspace(0, 1.1, int(1.1 * fs))
        beat = np.zeros(int(1.1 * fs))
        beat += gaussian(bt, 0.10, 0.022, 0.13)
        beat += gaussian(bt, 0.22, 0.008, -0.07)
        beat += gaussian(bt, 0.24, 0.010, 1.2)
        beat += gaussian(bt, 0.26, 0.008, -0.12)
        beat += gaussian(bt, 0.65, 0.070, 0.40)  # very late T = long QT
        end = min(q_start + len(beat), duration)
        sig[q_start:end] += beat[:end - q_start]
    # TdP burst: twisting QRS around baseline
    burst_start = 650
    burst_rate = 220
    burst_interval = int(fs * 60 / burst_rate)
    amplitude_env = np.sin(np.linspace(0, 3 * np.pi, (duration - burst_start)))
    t_burst = np.arange(duration - burst_start) / fs
    for i, q in enumerate(range(burst_start, duration, burst_interval)):
        amp = 0.8 * abs(np.sin(i * 0.35))
        sign = 1 if np.sin(i * 0.35) >= 0 else -1
        bt = np.linspace(0, burst_interval / fs, burst_interval)
        beat = sign * amp * (
            gaussian(bt, bt[-1]*0.3, 0.010, -0.15) +
            gaussian(bt, bt[-1]*0.5, 0.015, 1.0) +
            gaussian(bt, bt[-1]*0.7, 0.010, -0.20)
        )
        end = min(q + burst_interval, duration)
        sig[q:end] += beat[:end - q]
    return sig

CASES.append({
    "title": "Case 10 — 54-year-old female, recurrent syncope on amiodarone",
    "vitals": "HR variable | BP unobtainable during episode | QTc 560 ms baseline",
    "signal": case10(),
    "lead": "Lead II — rhythm strip",
    "diagnosis": "TORSADES DE POINTES (TdP) — Drug-induced Long QT",
    "findings": [
        "Preceding prolonged QT interval (QTc ≥500 ms)",
        "Classic twisting of QRS axis around isoelectric baseline",
        "Rate 200–250 bpm during TdP",
        "Polymorphic VT morphology — QRS amplitude waxes and wanes",
        "Initiated by short-long-short R-R sequence (pause-dependent)",
    ],
    "teaching": (
        "TdP = polymorphic VT in setting of prolonged QT. "
        "Causes: QT-prolonging drugs (amiodarone, sotalol, haloperidol, macrolides, fluoroquinolones), "
        "hypokalemia, hypomagnesemia, congenital LQTS. "
        "Treatment: Mg²⁺ sulfate 2 g IV bolus (drug of choice), "
        "correct electrolytes, overdrive pacing, isoproterenol (increase HR to shorten QT). "
        "Stop offending drug. AVOID amiodarone and other QT-prolongers."
    ),
})

# ── render ────────────────────────────────────────────────────────────────────

def render_case(case, idx, out_dir):
    fig = plt.figure(figsize=(16, 9), facecolor='white')
    fig.patch.set_facecolor('white')

    # Layout
    gs = GridSpec(3, 1, figure=fig,
                  height_ratios=[0.28, 1.5, 0.55],
                  hspace=0.35)

    # ── Header ──
    ax_head = fig.add_subplot(gs[0])
    ax_head.axis('off')
    ax_head.text(0.01, 0.85, case["title"],
                 fontsize=14, fontweight='bold', color='#1a1a2e', va='top')
    ax_head.text(0.01, 0.45, f"Vitals: {case['vitals']}",
                 fontsize=10, color='#333333', va='top', style='italic')
    ax_head.text(0.01, 0.10, f"Lead shown: {case['lead']}",
                 fontsize=9, color='#555555', va='top')
    # Red diagnosis box
    ax_head.text(0.99, 0.50, f"⚡ {case['diagnosis']}",
                 fontsize=13, fontweight='bold', color='white',
                 va='center', ha='right',
                 bbox=dict(facecolor='#c0392b', edgecolor='none',
                           boxstyle='round,pad=0.4', alpha=0.92))

    # ── ECG Trace ──
    ax_ecg = fig.add_subplot(gs[1])
    fs = 250
    sig = case["signal"]
    draw_grid(ax_ecg, len(sig) / fs)
    plot_ecg(ax_ecg, sig, fs)
    ax_ecg.set_ylabel("Amplitude (mV)", fontsize=8, color='#666666')
    # 1 mV calibration marker
    ax_ecg.annotate('', xy=(0.08, 1.0), xytext=(0.08, 0.0),
                    arrowprops=dict(arrowstyle='-', color='blue', lw=1.5))
    ax_ecg.text(0.06, 0.5, '1 mV', fontsize=7, color='blue', ha='right', va='center')
    ax_ecg.set_title("ECG Rhythm Strip  |  25 mm/s  |  10 mm/mV",
                     fontsize=9, color='#444444', loc='right', pad=3)

    # ── Findings + Teaching ──
    ax_info = fig.add_subplot(gs[2])
    ax_info.axis('off')

    # Findings column
    findings_text = "KEY FINDINGS:\n" + "\n".join(f"  • {f}" for f in case["findings"])
    ax_info.text(0.01, 0.98, findings_text,
                 fontsize=8.5, va='top', ha='left', color='#1a1a2e',
                 fontfamily='monospace',
                 bbox=dict(facecolor='#eaf4fb', edgecolor='#aed6f1',
                           boxstyle='round,pad=0.5', alpha=0.9))

    # Teaching point
    ax_info.text(0.62, 0.98,
                 "TEACHING POINT:\n" + case["teaching"],
                 fontsize=8, va='top', ha='left', color='#1a1a2e',
                 wrap=True,
                 bbox=dict(facecolor='#fef9e7', edgecolor='#f9e79f',
                           boxstyle='round,pad=0.5', alpha=0.9))

    # Page number
    ax_info.text(0.99, 0.02, f"Case {idx}/10", fontsize=8,
                 ha='right', va='bottom', color='#999999')

    fname = os.path.join(out_dir, f"ecg_case_{idx:02d}.png")
    fig.savefig(fname, dpi=150, bbox_inches='tight', facecolor='white')
    plt.close(fig)
    print(f"  Saved: {fname}")
    return fname

# ── main ──────────────────────────────────────────────────────────────────────

print("Generating 10 ECG cases...")
file_list = []
for i, case in enumerate(CASES, start=1):
    f = render_case(case, i, OUT_DIR)
    file_list.append(f)

print(f"\nDone! {len(file_list)} ECG images saved to {OUT_DIR}")

# ── Combine into a single PDF ─────────────────────────────────────────────────
try:
    from reportlab.lib.pagesizes import A4, landscape
    from reportlab.platypus import SimpleDocTemplate, Image as RLImage, Spacer
    from reportlab.lib.units import inch

    pdf_path = "/home/daytona/workspace/ecg-cases/output/10_ECG_Cases.pdf"
    doc = SimpleDocTemplate(pdf_path, pagesize=landscape(A4),
                            leftMargin=0.3*inch, rightMargin=0.3*inch,
                            topMargin=0.3*inch, bottomMargin=0.3*inch)
    story = []
    for f in file_list:
        img = RLImage(f, width=10.5*inch, height=5.9*inch)
        story.append(img)
    doc.build(story)
    print(f"PDF saved: {pdf_path}")
except Exception as e:
    print(f"PDF generation note: {e}")

cd /home/daytona/workspace/ecg-cases && python3 generate_ecgs.py 2>&1