Introduction: Cardiovascular diseases remain as the principal cause of death in Malaysia. The rural areas in Sabah still suffer from shortage of doctors and specialists. Health Indicators 2018 from Ministry of Health Malaysia shows the ratio of doctor to population in Sabah is 1:1029. The lack of specialist care for the rural population is a major concern. To overcome the barrier of healthcare services, deployment of telecardiology system is necessary. The objective of this project is to develop a real-time telecardiology system that can transmit and guarantee the quality of the ECG signal. Methods: The proposed real-time telecardiology system used an ECG sensor AD8232 to collect the ECG signal. Arduino ESP32 as a main controller of the system. It uploads the collected ECG data to the online database in real-time through Wi-Fi or cellular network with MQTT protocol. A website is developed for displaying the real-time ECG signal. Results: The proposed system has successfully displayed the ECG signal in real-time with 10000 ECG raw data were tested and stored in online database with no package loss and package error during the data transmission. The online system able to display real-time ECG signal and BPM on webpage. The real-time BPM is extracted from the real-time ECG raw data. Conclusion: The proposed real-time telecardiology system has success-fully transmitted ECG in real-time with high data integrity. Telecardiology is one of the best solutions to resolve the issue of shortage of healthcare professionals in rural areas and improve the healthcare quality in rural areas.