trainwheel rhythm (medicine) and ESA (iou)

trainwheel rhythm (medicine)

trainwheel rhythm -->
quadruple rhythm

A quadruple cadence to the heart sounds due to the easy audibility of both third and fourth heart sounds, indicative of serious myocardial disease.

Synonym: trainwheel rhythm.

ESA (iou)

ESA abbreviation.
Environmentally sensitive area.
European Space Agency.

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