A lack of cardiologists in remote areas can delay the diagnosis and the adequate management of cardiovascular emergencies. The digital tele-ECG system (DES) allows electronic data transmission to, and interpretation by, a remote cardiologist. An urban and a rural hospital in Sao Lourenco do Sul city and an outpatient unit in Turucu city employed the DES in Jan 2000, Jan 2001 and June 2003, respectively. DES includes a digital ECG machine, standard computers, a modem connection, telecommunication software and fixed or mobile phones. It allows data to be recorded, transmitted for immediate analysis and stored. A cardiologist performs the ECG analysis remotely, via either fixed or mobile phone, using the same telecommunication software. A total of 1950 digital tele-ECGs have been made in the three locations. The time between data transmission and analysis with online DES is around 9 min in online transmissions. The low cost of this system makes it useful and appropriate for small cities of developing countries where cardiologists are not available for on-site consultation. DES has promoted a significant improvement in the acute management of patients with a consequent decrease in the morbidity and mortality rates from cardiovascular diseases.