A small cardiothoracic ratio (CTR) is defined as a cardiothoracic ratio <42%/0.42 when assessed on a PA chest radiograph, and is often called small heart syndrome. A pathologically-small heart is also known as microcardia.
It can be due to/associated with a number of entities:
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cachectic state
advanced age
advanced malignancy
asthmatic paroxysm with emphysema
myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) 3
physiological factors: e.g. Valsalva maneuver
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