Module 05 · Education only

Congestion tracker

Plot a teaching case's filling pressures on the RAP–PCWP plane over time and watch what diuresis, inotropes, or mechanical unloading do to the ratio between the two sides of the heart.

Timepoints

Enter the RAP and PCWP at each step. CO and PA saturation are optional.

4 rows

Load a preset

#	Timepoint	RAP mmHg	PCWP mmHg	CO L/min	PA sat %	Intervention	Reorder or remove
1
2
3
4

Body size (optional)

Needed only to index cardiac output. Mosteller BSA.

Heightin

Weightlb

BSA

—m²

RAP–PCWP plane

Points are numbered in order; the current point is ringed. Regions are a teaching grid, not a prognostic tool.

Point size ∝ CO

Larger circle, larger output

Key to the regions

The same rules the calculator's phenotype uses.

Normal range: RAP ≤6 and PCWP ≤12
Low filling: RAP <2 and PCWP <5
LV-predominant: PCWP >18, otherwise (ratio ≤0.63 or RAP <10)
Biventricular: PCWP >18, RAP ≥10, ratio >0.63
RV-predominant: RAP ≥10, PCWP ≤18, ratio >0.63
RAP:PCWP 0.63: pre-LVAD cohort cutoff (Kormos), borrowed here as a teaching boundary for a disproportionately high RA pressureKormos 2010.
PCWP 18: the Forrester "wet" line of the teaching gridForrester 1976.

Timepoints on the plane

Hover or tap a point on the plane for the same details.

1
Admission
RAP 18 · PCWP 28 · ratio 0.64 · CO 3.8 · PA sat 58%
2
Day 1 (−3 L)diuresis
RAP 14 · PCWP 23 · ratio 0.61 · CO 4.0 · PA sat 60%
3
Day 2 (−6 L)diuresis
RAP 10 · PCWP 18 · ratio 0.56 · CO 4.3 · PA sat 63%
4
Day 3 (−8 L)diuresis
RAP 7 · PCWP 14 · ratio 0.50 · CO 4.5 · PA sat 66%

What the trajectory shows

Generated from the rows above; it describes a teaching case, not a patient. Regions and ratios here describe where pressures sit and do not predict outcomes.

RAP fell 18→7 and PCWP fell 28→14 mmHg across 4 timepoints; RAP:PCWP fell from 0.64 to 0.50.
Started in the biventricular region; the current point (RAP 7, PCWP 14) is between the shaded zones.
CO rose 3.8→4.5 L/min.
PA saturation rose 58→66%, consistent with improved oxygen delivery relative to demand.

Per-timepoint readouts

#	RAP:PCWP	CI	Teaching region
1	0.64>0.63	CO 3.8	Biventricular
2	0.61	CO 4.0	LV-predominant
3	0.56	CO 4.3	Between zones
4	0.50	CO 4.5	Between zones

PAPi is not shown here: it needs PA systolic and diastolic pressures, which this tracker does not collect. CI needs CO plus height and weight.

Teaching points

RAP:PCWP 0.63 is the cutoff reported in a pre-LVAD cohortKormos 2010. This tracker borrows it only as a teaching boundary for "RA pressure that is disproportionately high relative to the wedge"; it came from one population and is not a validated threshold for other settings. The regions and the ratio describe where a case sits on the grid; they are not used here to predict outcomes. The SHOCK-trial hemodynamic analysisLala 2018 did not show a statistically significant survival association for hemodynamic RV dysfunction, and its specific RAP:PCWP cutoffs were not verified, so no cutoff is attributed to it and none is drawn.

When an Impella or LVAD lowers the wedge, venous return to the RV can rise. A RAP that climbs while PCWP falls raises the question of how well the RV is tolerating the added preload; on an LVAD, a similar pattern at high speed can also reflect suction events. Read the pressures together with the echocardiogram, the clinical picture and the device dataHsu 2022.

In the Cardiogenic Shock Working Group registry, patients whose PA-catheter data were complete (RAP, PA pressures, PCWP and output, allowing PAPi, CPO and the ratio to be calculated) had lower in-hospital mortality than those with partial or no dataGaran 2020. An association, not a trial result, but a reason to collect every number this plane needs.

In advanced decompensated heart failure, venous congestion (a high RAP) was associated with worsening renal functionMullens 2009. Yet CVP alone does not predict whether stroke volume will rise with fluid: a meta-analysis found only a weak relationship between CVP and fluid responsivenessMarik 2013. High RAP tells you about congestion; it does not tell you whether to give or remove volume by itself.

How the regions are drawn

Normal: RAP ≤6 and PCWP ≤12 mmHg, the textbook rangesKern 2022 Naderi 2024.
Low filling: RAP <2 and PCWP <5 mmHg.
Biventricular: PCWP >18 (the Forrester "wet" lineForrester 1976), RAP ≥10 and RAP:PCWP >0.63.
LV-predominant: PCWP >18 otherwise, that is with RAP:PCWP ≤0.63 or RAP <10.
RV-predominant: RAP ≥10, PCWP ≤18 and RAP:PCWP >0.63.
The 0.63 ratio is the pre-LVAD cohort cutoffKormos 2010, used here as a teaching boundary. These definitions are the ones the calculator's phenotype uses, so the plane and the calculator agree.
Points that fall outside every shaded zone are labeled "between zones"; the tracker is deliberately silent rather than forcing a label.
The regions and ratios locate a case on a teaching grid. They are not used to predict prognosis or to decide therapy.