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Atrial flutter at a rate of 260 with 2:1 atrioventricular conduction was missed by the electrocardiogram computer program and misdiagnosed as inferior wall ST-elevation myocardial infarction. Possible resulting clinical errors and computer programming issues are discussed.Errors in diagnosis often lead to errors in treatment and poor clinical results. 1,2 Computer diagnostic statements of cardiac rhythm and the QRS/T analysis also provided are frequently incorrect. 3,4 Errors in both diagnostic categories may result in inappropriate clinical management and possible harm to the patient. 5 An emergency department electrocardiogram was obtained for a 62-year-old man with altered mental status (Figure). The computer diagnoses (GE/MUSE 8, General Electric Healthcare, Wauwatosa, Wis) of sinus tachycardia and inferior wall ST-elevation myocardial infarction were both incorrect. The rhythm was atrial flutter with 2:1 atrioventricular conduction. ST-elevation myocardial infarction is not present.Possible treatment errors include failure to address the flutter with appropriate rate or rhythm control, and perhaps anticoagulation, because many patients with flutter manifest atrial fibrillation intermittently 6,7 with risk of embolic stroke and inappropriate treatment of presumed ST-elevation myocardial infarction with cardiac catheterization, thrombolysis, and antiplatelet therapy.The nonconducted flutter waves were not identified as atrial, but as ST-segment deviation. In 2:1 flutter, discrimination between T waves and flutter waves is difficult for computer algorithms. Flutter waves may corrupt STsegment measurements. However, if flutter is identified, the computer program will become more reliable for inferior ST abnormalities. In this case, the atrial flutter was not detected. Rather, in lead II (Figure ), a short isoelectric Conflict of Interest: None.