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<div class="notice">
<p>
This software is described in
<p class="reference">
T Heldt, R Mukkamala, GB Moody, and RG Mark.
<a href="45TOPETJ.pdf">CVSim: An Open-Source Cardiovascular Simulator for
Teaching and Research</a>. <i>Open Pacing, Electrophysiol & Ther J</i>
<b>3</b>:45-54 (2010).
</p>
<p>
<b>Please cite this publication when referencing this software, and also include
the standard citation for PhysioNet:</b>
<div class="reference">
<p>Goldberger AL, Amaral LAN, Glass L, Hausdorff JM, Ivanov PCh, Mark RG,
Mietus JE, Moody GB, Peng C-K, Stanley HE. PhysioBank, PhysioToolkit, and
PhysioNet: Components of a New Research Resource for Complex Physiologic
Signals.
<i>Circulation</i> <b>101</b>(23):e215-e220 [Circulation Electronic Pages;
<a href="http://circ.ahajournals.org/content/101/23/e215.full"
target="other">http://circ.ahajournals.org/content/101/23/e215.full</a>];
2000 (June 13).
</p>
</div> <!-- end reference -->
<p>
If you teach using CVSim, please
<a href="mailto:webmaster@physionet.org?subject=CVSim educational use">tell us
about your course</a>.
<p>
The <b>CVSim</b> software was developed between 1983 and 2007, and four
versions of it are available from PhysioNet:
<ul>
<li><a href="../xcvsim/"><b>XCVSim</b></a> (1991-1998), a 6-compartment model
with an X11 GUI
<li><a href="../rcvsim/"><b>RCVSim</b></a> (2000-2003), a 6-compartment model
with a scriptable command-line interface
<li><a href="#cvsim-6"><b>CVSim-6</b></a> (2002-2007), a 6-compartment model with a Java GUI (described
below)
<li><a href="#cvsim-21"><b>CVSim-21</b></a> (2002-2007),
a 21-compartment model with an enhanced Java GUI (also described below)
</ul>
</div>
<h1 align=center>CVSim: a cardiovascular simulator</h1>
<p>
<b>CVSim</b> is a lumped-parameter model of the human cardiovascular
system that has been developed and used for research and for teaching
quantitative physiology courses at MIT and Harvard Medical School since
1984. The versions presented here have a graphical user
interface implemented in Java, with computational components in C.
The portable C code has been compiled for popular platforms, and users
of Linux (x86), Mac OS X (PPC and x86), and MS Windows (x86) should be
able to use the links below to run CVsim.
<p>
<b>CVSim requires the 32-bit Sun/Oracle Java Runtime Environment (JRE
6 or 7 but not later)</b>, running on a 32- or 64-bit version of Linux, Mac OS X, or
MS-Windows. CVSim will not run on 64-bit versions of
the JRE, on any version of OpenJDK (IcedTea), or on Solaris.
<p>
CVSim has been tested successfully using 32-bit JRE 7 on 64-bit Windows 7 and 64-bit Windows 10;
32-bit JRE 6 on 32-bit Windows XP, 32- and 64-bit Windows 7, Mac OS X (PPC, x86, and x86_64, 32-bit versions 10.4 and 10.5, and 64-bit 10.6), and many versions of 32- and 64-bit Linux including Fedora (4 through 19), Red Hat Enterprise
Linux 4, and Ubuntu 8.04, 10.04, and 12.04.
<a name="cvsim-6"><h2>Prerequisites for the Educational Version of CVSim (CVSim-6)</h2></a>
<p>
In order to run the educational version of CVSim,
<b>Java Web Start</b> must be installed on your computer. Since it is
included in all recent versions of the Java Runtime Engine (JRE), this
may have been done already. If not:
<ul>
<b>Linux:</b> Install a <b>32-bit version</b> of JRE 6 (or JDK 6,
which includes JRE 6)
from <a href="http://www.oracle.com/technetwork/java/javase/downloads/index.html"
target="other">oracle.com</a>
or <a href="http://www.oracle.com/technetwork/java/javase/6/webnotes/install/"
target="other">java.sun.com</a>, then follow the instructions on
<a href="http://www.oracle.com/technetwork/java/javase/manual-plugin-install-linux-136395.html"
target="other">oracle.com</a> or <a
href="http://www.oracle.com/technetwork/java/javase/6/webnotes/install/jre/manual-plugin-install-linux.html"
target="other">java.sun.com</a> to install the Java plugin in your web browser.
<br>
<b>Mac OS X:</b> Run <b>Software Update</b> from <b>System Preferences</b>.
Install Java for Mac OS X. (If 64-bit versions become available, you will
need to select a 32-bit version.)
<br>
<b>Windows:</b> Install a <b>32-bit version</b> of JRE 6 (or JDK 6,
which includes JRE 6)
from <a href="http://www.oracle.com/technetwork/java/javase/downloads/index.html"
target="other">oracle.com</a>
or <a href="http://www.oracle.com/technetwork/java/javase/6/webnotes/install/"
target="other">java.sun.com</a>.
</ul>
<p>
Some 64-bit browsers (such as 64-bit versions of IE 8) are incompatible with
32-bit versions of Java. If this is the case for your browser, install and
use a 32-bit browser in order to install the 32-bit JRE and launch CVSim. You
do not need to change your OS or remove your 64-bit browser in order to do so.
<p>
You need to do this at most once on any computer on which you will
use CVSim. Restart your browser after installing or updating Java.
<p>
<b>Important! If both 32- and 64-bit JREs are installed, the 32-bit JRE must
have a newer version number.</b> If both JREs have the same version number,
or if the 64-bit JRE has a newer one, it will not be possible to launch the
32-bit JRE successfully, and in this case you must uninstall the 64-bit JRE.
For example, the presence of 64-bit JRE 7 will prevent 32-bit JRE 7 from
launching, but 64-bit JRE 6 will not interfere with 32-bit JRE 7. The
instructions for uninstalling a Java package on Windows are at
<a href="http://www.java.com/en/download/help/uninstall_java.xml"
target="other">http://www.java.com/en/download/help/uninstall_java.xml</a>.
<h2>Launching the Educational Version of CVSim</h2>
<p>
Once Java Web Start has been installed on your computer,
one of the two links below can be used to start CVSim.
<center>
<a href="http://physionet.org/physiotools/cvsim/cvsim_deploy.jnlp">Launch
CVSim [physionet.org]</a>
<a href="cvsim_deploy.jnlp">Launch CVSim [alternate]</a>
</center>
<p>
<b>PhysioNet mirror users:</b> Try the alternate link first. If it doesn't
work, the first link can be used to launch CVSim from the master PhysioNet
server. When you attempt to launch CVSim, alerts about the risks of doing
so will appear (see details for <a href="#jre6">JRE 6</a> and
<a href="#jre7">JRE 7</a>).
<p>
<b>IcedTea Web Start:</b> On Linux (and perhaps on other platforms),
your browser may suggest launching CVSim using the IcedTea Web Start
application. Try it if you wish, and please let us know if you are
successful; as of this writing, we have not had success using IcedTea
Web Start and we have not heard from anyone else who has. As noted in
the previous section, the Sun (now Oracle) JRE 6 or 7, its Java plugin, and
its Web Start application are known to work and are recommended. The
Sun/Oracle Java Web Start application, <tt>javaws</tt>, is installed
in <tt>/usr/java/jre1.<em>n.n_nn</em>/bin/javaws</tt> on Fedora Linux;
this may vary on other platforms.
<a name="cvsim-21"><h2>Research version of CVSIM (CVSim-21)</h2></a>
<p>
Sources for the research version of CVSim, which includes the
six-compartment teaching model available above as well as a more
detailed model containing 21 compartments, are available as
a <a href="cvsim.tar.gz">gzip-compressed tar archive</a>, or you may
get individual files from the <a href="cvsim/">source tree</a>.
<p>
Precompiled binaries of the research version of CVSim are also
available for <a href="cvsim-linux.tar.gz">GNU/Linux</a>
and <a href="cvsim-windows.zip">Windows</a>. (These binaries must be
downloaded and unpacked before they can be run. Instructions for
using them are included in each package.)
<p>
For reference, you may also wish to study an older implementation (see
<a href="../rcvsim/">RCVSIM</a> or <a href="../xcvsim/">XCVSim</a>).
<h1>Using CVSim</h1>
<p>
The notes below apply to both the educational and the research versions of
CVSim.
<h2>CVSim Window Components</h2>
<p>
The CVSim window is divided into four sections ("panes") and a toolbar:
<p>
<center><img src="images/cvsim_gui_annotated_small1.jpg"
title="[CVSim window]">
</center>
These components are briefly described here, and demonstrated in short Flash
animations (click on the links below to see them).
<h3>Simulation Control Toolbar</h3>
<p>
The <a href="demos/controls.htm">Simulation Control Toolbar</a>
includes six controls to stop and start the simulation and turn the
control systems on and off:
<center><table width="50%" cellpadding=10>
<tr><td><img src="images/go2.gif"></td><td>Start the simulation</td></tr>
<tr><td><img src="images/stop3.gif"></td><td>Stop the simulation</td></tr>
<tr><td><img src="images/ABgo4.gif"></td><td>Turn on the arterial baroreflex
control system</td></tr>
<tr><td><img src="images/ABstop5.gif"></td><td>Turn off the arterial baroreflex
control system</td></tr>
<tr><td><img src="images/CPgo6.gif"></td><td>Turn on the cardiopulmonary reflex
control system</td></tr>
<tr><td><img src="images/CPstop7.gif"></td><td>Turn off the cardiopulmonary
reflex control system</td></tr>
</table></center>
<h3>Simulation Parameters Pane</h3>
<p>
The <a href="demos/variables.htm">Simulation Parameters Pane</a>
displays the simulation variables and outputs. (The Simulation Outputs
Pane, which is located on a separate tab behind the Simulation Parameters
Pane, is not functional in the current version of CVSim. In a future version,
it will be used to select outputs to be recorded in a log file.)
<h3>Graphics Pane</h3>
<p>
The <a href="demos/graphics.htm">Graphics Pane</a> displays anatomical
and circuit representations of the simulation model.
<p>
Click and drag the vertical bar between the <b>Simulation Parameters</b> and
<b>Graphics</b> panes to resize them.
<h3>Strip Chart and Plot Panes</h3>
<p>
The <b>Strip Chart</b> behaves like a chart recorder, plotting
simulation outputs versus time and scrolling from right to left. The
<b>Plot Pane</b> behaves like a flatbed XY plotter, plotting
simulation outputs versus one another. Watch the <a
href="demos/plots.htm">Strip Chart and Plot demo</a>.
<p>
Strip Chart and Plot panes can be undocked using the arrow icon at the
upper right corner of the pane. Once undocked, they can be moved and
resized, and it is possible to view more than one of each simultaneously.
(Select <b>New Strip Chart</b> or <b>New Plot</b> from the main window's
Plot menu to create additional strip charts or plots.)
<h2>Printing</h2>
<p>
There is no built-in facility for printing. Linux
users can take a snapshot of the screen using the <b>PrintScreen</b> key,
or of a single window (such as an undocked strip chart pane) using
<b>Alt</b>+<b>PrintScreen</b>. Most image viewers (such as <tt>eog</tt>,
<tt>gimp</tt>, <tt>gqview</tt>. or <tt>kview</tt>) can display and print
these snapshots. Similar facilities may be available on other platforms.
<h2>Differences Between the Educational and Research Versions</h2>
<p>
The educational version includes the six-compartment model only, and there
are minor user-interface differences with respect to the research version.
Notably, the menu bar of the educational version includes a <b>Patient</b>
menu; selecting a patient allows a student to explore what perturbations
of cardiovascular parameters might account for a given set of symptoms,
and what interventions might be effective in improving the CV state of
the virtual patient. The research version includes both 6- and 21-compartment
models (you must choose one of these at the beginning of the simulation),
and offers greater flexibility in performing experiments using the model.
The current research version allows the user to perform virtual tilt tests,
for example.
<h2>Java security</h2>
<p>
There are risks inherent in running Java as well as any other
applications downloaded from the Internet. We have checked CVSim very
carefully to ensure that downloading and running it will not pose a
risk to your privacy, your personal or other files, your computer, or
those of anyone else. JRE 7, and to a lesser extent JRE 6, will alert
you with respect to the risks; the notes below summarize the alerts
that you should expect to encounter when launching CVSim.
<a name="jre7"><h3>Running on JRE 7</h3></a>
<p>
JRE 7 will alert you to the dangers of running untrusted Java applications
at least 3 times before allowing you to do so. The first of these alerts
has the title <b>Application Blocked</b>, and the text
<pre>
Application Blocked by Security Settings<br>
Your security settings have blocked a self-signed application from running
</pre>
<p>
The workaround for this alert is described at
<a href="http://www.java.com/en/download/help/java_blocked.xml"
>http://www.java.com/en/download/help/java_blocked.xml</a> :
<pre>
Go to the Java Control Panel (On Windows, click Start and then Configure
Java)<br>
[On Windows 7, click the Windows logo at the lower left corner of the screen,
then <b>All Programs</b>, then <b>Java</b>, then <b>Configure Java</b>.]</i><br>
Click on the <b>Security</b> tab<br>
Click on the <b>Edit Site List</b> button<br>
Click the <b>Add</b> in the <b>Exception Site List</b> window<br>
Click in the empty field under <b>Location</b> field to enter the URL
</pre>
<p>
In the <b>Location</b> field, type
<pre>
http://physionet.org
</pre>
<p>
and click <b>OK</b>. Now this window pops up:
<pre>
Including an HTTP Location on the Exception Site List is
considered a security risk
Location: http://physionet.org
Locations that use HTTP are a security risk and may compromise the personal
information on your computer. We recommend including only HTTPS sites on
the Exception Site List.
Click <b>Continue</b> to accept this location or <b>Cancel</b> to abort this change.
</pre>
<p>
Click <b>Continue</b>, then click <b>OK</b> again. These alerts
should not reappear on later use of CVSim. Click again on the CVSim
link, and a final alert (which will return on each use of CVSim) will
appear:
<pre>
Security Warning
Do you want to run this application?
Publisher: UNKNOWN
Location: http://physionet.org
Running this application may be a security risk
Risk: This application will run with unrestricted access which may put
your computer and personal information at risk. The information
provided is unreliable or unknown so it is recommended not to run
this application unless you are familiar with its source
More information
Select the box below, then click <b>Run</b> to start the application
[ ] I accept the risk and want to run this application [Run] [Cancel]
</pre>
<p>
Check the box and click <b>Run</b>.
<a name="jre6"><h3>Running on JRE 6</h3></a>
<p>
The first time you run CVSim, a <a href="images/warning.png">
warning</a> will appear. (<b>Internet Explorer users:</b> The security
warning may be displayed behind your browser.)
<p>
Click <b>Run</b>. (To avoid the warning in the future, first check
<b>Always trust content from this publisher</b>).
<h2>Acknowledgments</h2>
<p>
This implementation of CVSim is the work of Catherine Dunn and Thomas Heldt,
with contributions from Ali Saeed and Brandon Pierquet.
<p>
Previous implementations were written by Bob Sah (1983), George
Moody (1985), Tim Davis (1989), Rama Mukkamala (2001), Thomas Heldt
(2002), and by Eun Bo Shim and his students (2003). The circulatory
model used in CVSim was created by Roger Mark, based on an analog
model of JG Defares and colleagues [2]. The CVSim model was
elaborated by Thomas Heldt, Eun Bo Shim, Roger Kamm, and Roger Mark
[3].
<p>
Development of CVSim was supported in part through the National
Aeronautics and Space Administration (NASA) Cooperative Agreement NCC
9-58 with the National Space Biomedical Research Institute (grants
CA00106, CA00205, and CA00403).
<h2 id="references">References</h2></a>
<p>
[1] T Heldt, R Mukkamala, GB Moody, and RG Mark.
<a href="45TOPETJ.pdf">CVSim: An Open-Source Cardiovascular Simulator for
Teaching and Research</a>. <i>Open Pacing, Electrophysiol & Ther J</i>
<b>3</b>:45-54 (2010).</p>
<p>
[2] JG Defares, JJ Osborne, and HH Hara.
<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14168416&dopt=Abstract" target="other">
Theoretical synthesis of the cardiovascular
system. Study I: The controlled system</a>. <i>Acta Physiol Pharmacol
Neerl</i> <b>12</b>:189-265 (1963). </p>
<p>
[3] T Heldt, EB Shim, RD Kamm, and RG Mark. <a
href="http://jap.physiology.org/cgi/content/full/92/3/1239"
target="other">Computational modeling of cardiovascular response to
orthostatic stress</a>.
<i>J Appl Physiol</i> <b>92</b>(3):1239-1254 (2002 March 1).</p>
<h2>Related Links</h2>
<ul>
<li> <a href="../rcvsim/">A Cardiovascular Simulator for Research</a>.
<b>RCVSIM</b> is Rama Mukkamala's 2001 version of the CVSim model, and
was developed using MATLAB. MATLAB is not required to run RCVSIM
under Linux. The output of RCVSIM can be read and manipulated further
using the <a href="../wfdb.shtml">WFDB</a> software package.
<li> <a href="../xcvsim/">XCVSim</a>. Sources and Linux binaries for Tim
Davis's 1989 implementation of CVSim for X10 on MIT's Project Athena,
with revisions by George Moody for X11 on GNU/Linux and other Unix
platforms.
<li> <a href="http://ocw.mit.edu/courses/health-sciences-and-technology/hst-542j-quantitative-physiology-organ-transport-systems-spring-2004/"
target="other">Quantitative Physiology: Organ Transport Systems</a>.
This MIT OpenCourseWare course is based on Roger Mark's spring 2004
course, which used XCVSim. CVSim-6 was first used in this course in
spring 2007.
</ul>
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