Objective To assess the efficacy and safety of low dose short-term tolvaptan in treatment of decompensated heart failure patients with diuretic resistance and hyponatremia. Methods The clinical data of consecutive patients with decompensated heart failure, who were admitted to Changzheng Hospital from April 2012 to March 2014, were analyzed retrospectively. Patients were assigned to receiving tolvaptan (15 mg/d×7 d) or standard therapy (including 3%-4% hypertonic saline×7 d). The efficacy endpoints were heart failure symptoms relief, serum sodium elevation during hospitalization and cardiovascular death at 180 d from discharge. The safety endpoint included adverse effect of thirsty, renal function impairment and symptoms of nervous system. Results A total of 37 patients met the inclusion criteria and were assigned to tolvaptan (n=16) or standard therapy (n=21). There were no significant differences between the 2 groups at baseline. The elevation of serum sodium at day 7, reduction of body weight and NT-proBNP level before discharge, and the ratio of restoration to higher than NYHA class Ⅱin the tolvaptan group were all significantly more than those in the standard therapy group (P<0.05). Tolvaptan, compared with standard therapy, significantly decreased the mean dose of furosemide, serum creatinine elevation and hospital stay (P<0.05), but failed to lower the cardiovascular mortality at 180 d follow-up. Conclusion For Chinese patients with decompensated heart failure with diuretic resistance and hyponatremia, in addition to guideline-recommended therapies for heart failure, low dose short term tolvaptan is associated with more favorable in-hospital effects and less severe adverse effects, but not with long-term cardiovascular mortality.