Twelve patients with clinical and hemodynamic evidence of severe congestive heart failure, unresponsive to the usual therapy of salt restriction, oxygen, bed rest, digitalis, and massive doses of diuretics, were studied during a control period and after intravenous dopamine. Seven patients survived and 5 died with intractable failure and shock despite transiently improved hemodynamic indices. At control period and after optimal dose of dopamine, there were no significant changes in heart rate (HR) and mean systemic arterial pressure. The mean pulmonary artery (PA) and pulmonary capillary wedge (PCW) pressures decreased slightly. Cardiac index (CI), stroke volume (SVI), and stroke work indices (SWI) rose (p less than 0.005) from the control values of 1.4 +/- 0.1, 15.3 +/- 5, and 13.6 +/- 1.7 to 2.2 +/- 0.1, 24.1 +/- 4, and 24 +/- 2.3, respectively; pulmonary arteriolar (PAR), total pulmonary vascular (TPVR), and systemic vascular (SVR) resistances fell (p less than 0.01). Urine output increased from 13.5 ml/hr before to 58.2 ml/hr after dopamine (p less than 0.005). After 24 and 48 hr of dopamine, in addition to the above hemodynamic changes, PA pressure fell from 38 +/- 4 to 33 +/- 3 and 28 +/- 2, and PCW from 30 +/- 2 to 24 +/- 3 and 18 +/- 3 (p less than 0.05). Compared with nonsurvivors, survivors had significant decreases in PA and PCW pressures, PAR, and TPVR and an increase in SWI. These data indicate that dopamine is effective in some patients with refractive congestive heart failure associated with acute oliguric renal failure and that the prognosis may be improved.