Patient description: A 62-year-old African-American man presented with left upper and lower extremity weakness, associated with dark visual spot in right eye, right facial numbness, facial drop and slurred speech. He denied dyspnea, headache, palpitations, chest pain, fever, dizziness, bowel or urinary incontinence, loss of consciousness. His medical history was significant for hypertension, hyperlipidemia and hypothyroidism. He smokes cigarette 1 pack per day for 40 years and alcohol consumption of 5 to 6 beers per week. He is not aware about his family history. He is using Levothyroxine, Atorvastatin and HTCZ. His vital signs were stable in the primary evaluation. Left-sided facial droop, dysarthria, and left-sided hemiplegia were seen in the physical exam. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. Intravenous recombinant tissue plasminogen activator (t-PA) was administered as well as high-dose statin therapy. The patient was admitted to the intensive care unit to be monitored for 24 hours. MRI of the head revealed an acute 1.7-cm infarct of the right periventricular white matter and posterior right basal ganglia.

Clinical trial eligibility criteria: eligible ages (years): 40.0-75.0,  Acute Coronary Syndrome Myocardial Infarction Unstable Angina Pectoris Participant had at least five minutes of chest pain or equivalent (chest tightness; pain radiating to left, right, or both arms or shoulders, back, neck, epigastrium, jaw/throat; or unexplained shortness of breath, syncope/presyncope, generalized weakness, nausea, or vomiting thought to be of cardiac origin) at rest or during exercise within 24 hours of ED presentation, warranting further risk stratification, as determined by an ED attending. 2. 2 or more cardiac risk factors (diabetes, hypertension, hyperlipidemia, current smoker and family history of coronary artery disease). 3. Able to provide a written informed consent. 4. <75 years of age, but >40 years of age. 5. Able to hold breath for at least 10 seconds. 6. Sinus rhythm  New diagnostic ischemic ECG changes (ST-segment elevation or depression > 1 mm or T-wave inversion > 4 mm) in more than two anatomically adjacent leads or left bundle branch block 2. Documented or self-reported history of CAD (MI, percutaneous coronary interventions [PCIs], coronary artery bypass graft [CABG], known significant coronary stenosis [>50%]) 3. Greater than 6 hours since presentation to ED. 4. BMI >40 kg/m2 5. Impaired renal function as defined by serum creatinine >1.5 mg/dL* 6. Elevated troponin-T (> 0.09 ng/ml) 7. Hemodynamically or clinically unstable condition (BP systolic < 80 mm Hg, atrial or ventricular arrhythmias, persistent chest pain despite adequate therapy) 8. Known allergy to iodinated contrast agent 9. Currently symptomatic asthma 10. Documented or self-reported cocaine use within the past 48 hours (acute) 11. On Metformin therapy and unable or unwilling to discontinue for 48 hours after the CT scan 12. Contraindication to beta blockers (taking daily antiasthmatic medication): This only applies to patients with a heart rate >65 bpm at sites using a non-dual source CT scanner 13. Participant with no telephone or cell phone numbers or no address (preventing follow-up) 14. Participant with positive pregnancy test. Women of childbearing potential, defined as <2 years of menopause in the absence of hysterectomy or tube ligation, must have a pregnancy test performed within 24 hours before the CT scan. 15. Participant unwilling to provide a written informed consent