Electron spin resonance spin trapping technique was used to measure the generation of active oxygen free radicals during the respiratory burst of phorbol myristate acetate-stimulated leukocytes, and the superoxide dismutase activity in healthy subjects and in patients with congestive heart failure. The authors also measured the concentration of peroxidation products (primarily malondialdehyde) by the thiobarbituric acid method. Experimental results showed that the electron spin resonance spectra obtained during the respiratory burst of polymorphonuclear leukocytes stimulated with phorbol myristate acetate primarily were those of the spin adduct of 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) with the superoxide anion and to a lesser extent those of DMPO with hydroxyl radical. Compared with healthy subjects, the release of oxygen free radicals in the respiratory burst of polymorphonuclear leukocytes stimulated with phorbol myristate acetate and the concentration of thiobarbituric acid reactive product in plasma were significantly increased in patients with congestive heart failure while the activity of superoxide dismutase was markedly lower. The increased production of oxygen free radicals by polymorphonuclear leukocytes and the decreased capability of antioxidative defences might play an important role in the generation and development of cardiac failure.