Circulation Studio is a hands-on cardiovascular simulator for curious beginners and early healthcare learners. Choose a starting point now; every mode remains available when you are ready to go further.
This preset has no assumed LV outflow gradient. Aortic diastolic pressure rises relative to LV diastolic pressure as the catheter enters the aorta. These are synthetic left-heart pressures with assumed gradients and LVEDP, not measurements inferred from RHC. Sequential peak-to-peak values are not simultaneous instantaneous or Doppler gradients. Readouts show reference systolic/diastolic pressures, not augmented diastolic peaks. During Impella or ECMO support, the aortic readout instead shows time-averaged MAP; its dashed guide marks that mean. IABP adds the same timed aortic augmentation as ART; deflation reduces the following LV/LVOT systolic peak by an illustrative 8 mmHg. LVEDP follows the current disease, compensation, rate and intervention model independently of wedge pressure. Mitral stenosis or MR v waves can elevate wedge without an equivalent LVEDP rise. The dashed guide marks LVEDP immediately before contraction; minimum diastolic pressure is lower. Restriction/constriction add an early dip and plateau unless tamponade is selected. Assistance follows the selected 1:1, 1:2 or 1:3 ratio. Balloon inflation does not create an LV diastolic pressure hump. Switching Off restores the unsupported model. The optional PVC capture illustrates post-extrasystolic LV/aortic changes separately from this sequential recording. Changing controls clears the recording.
Ao · mean 92LV · mean 45LA · mean 9mmHgVolume / sounds
LV pressure–volume
Live comparison · illustrative volumes
Normal referenceUntreated
1 · MC2 · AO3 · AC4 · MO
JVP10
0cm H₂O
CHEST RADIOGRAPH SYNTHETIC · PA
No modeled edemaPAWP 8 mmHgNo assumed cardiomegaly
IVC17 mm · 62% sniff collapse
Normal size · ≥50% collapse
CXR model
Illustrative opacities begin above a transmural filling-pressure proxy of 20 mmHg and increase to 40 mmHg. With PEEP, recruitment improves aeration and lower transmural filling reduces modeled congestion; transmitted airway pressure is excluded from the opacity estimate. PAWP below the image remains the measured pressure. This depicts a simplified later equilibrium, not immediate lung-fluid removal. Real edema depends on acuity, permeability and lymphatic adaptation; it may lag pressure changes. Cardiac silhouette reflects assumed chronic remodeling; pulmonary hypertension adds central vessel prominence and peripheral pruning. Effusions are illustrative at high congestion. No ARDS or immediate radiographic response is inferred clinically. This is not a predicted patient X-ray. Radiographic patterns · Positive pressure.
Numbers shift smoothly from black toward crimson and become bolder as they move farther outside their reference range or show greater waveform abnormality. The colour spectrum is an illustrative teaching cue, not a validated severity grade, diagnosis or treatment trigger.
Illustrative alert landmarks: mean PA ≥20; mean PCWP ≥20; LVEDP ≥20 mmHg; PVR >2 WU (>160 dyn·s/cm⁵). These landmarks do not cause abrupt colour changes or mean “very severe” disease: the ESC PH definition is mean PA >20 mmHg, and PCWP 16–19 is already above the ESC reference and gains progressively more emphasis.
Other alert landmarks: RA mean/minimum ≥15 or peak ≥20; RV peak ≥60 or RVEDP ≥15; PA peak ≥60 or minimum ≥25; wedge peak ≥30 or minimum ≥20; LV peak <80 or ≥180, minimum ≥20; Ao peak <90 or ≥180, minimum <40 or ≥110, mean <65 or ≥130 mmHg. CO <3 or >8 L/min; SVR <600 or ≥1600 dyn·s/cm⁵ (<7.5 or ≥20 WU). Apart from the ACC low-pressure warning criteria, these cutoffs are illustrative. IABP-augmented peaks can trigger alerts.
Atrial peaks/troughs follow their mean pressure, with extra emphasis for extreme waves. Ventricular minimum/mean colours reflect systolic and EDP abnormalities; no standalone normal ventricular mean is implied. Systemic mean colour also reflects abnormal systolic/diastolic pressure.
ESC/ERS 2022, Table 11 supplies available normal RHC ranges. ACC shock guidance (2025) identifies SBP <90 or MAP <65 as warning criteria and PCWP/LVEDP >15 as LV congestion in shock. Shock also requires evidence of hypoperfusion; it is not diagnosed by the table colour. Supplemental ventricular, arterial and SVR ranges are identified in the reference panel.
Pressures are displayed to the nearest whole mmHg; flow and Wood-unit resistance use one decimal place. Calculations, waveform generation and colour emphasis use the unrounded values. Small differences can result if you calculate from the rounded display.
Forward modeled CO. SVR = (mean Ao − mean RA) ÷ CO; PVR = (mean PA − mean wedge) ÷ pulmonary flow. Pulmonary flow equals systemic flow only without shunts or bypass. Qp includes net shunt flow and excludes the ECMO bypass. 1 Wood unit = 80 dyn·s/cm⁵. Resistance is undefined at zero output.
Ao is central aortic pressure. The peripheral ART trace has modest pulse-pressure amplification and transit delay, with approximately preserved mean pressure. This is an illustrative radial waveform transfer, not a patient-specific conversion. Arterial waveform reference.
Updates with conditions, rhythm, rate and IABP. Sys/Dia show the maximum/minimum over the modeled rhythm sequence; Mean is the time average. IABP augmentation is included. For NSVT, peak and trough can come from different beats; the full repeating sequence includes baseline rhythm and VT bursts. Flow is averaged over that same sequence.
For RA and wedge, Sys/Dia represent waveform peaks/troughs, not ventricular systole/diastole. Ventricular Dia is the minimum, not EDP. Wedge estimates LA pressure, not LVEDP.
Mean wedge is an LA pressure proxy, not LVEDP. A large v wave may raise the mean; wedge–LV timing must be aligned before judging a mitral gradient. Wedge and LVEDP explained ↗
