A variant of compensated cardiogenic shock occurring in patients with chronic congestive heart failure following an episode of pulmonary edema, and in the absence of hypotension, is described. The clinical picture is characterized by combined renal and hepatic injury and a severe, often fatal, course and is distinct from other subsets of cardiogenic shock. When the splanchnic vasodilator dopamine was added to the patients’ management, the outcome was uniformly favorable. This variant of compensated cardiogenic shock requires early diagnosis and treatment. The apparently beneficial effect of low-dose dopamine needs further evaluation.