ECG and Echocardiography are important tools for the diagnosis and management of cardiovascular patients. The transmission of medical images from remote understaffed centers to any big hospital through the use of Internet Protocol (IP) is now a possibility and would enhance diagnosis and management and thereby eliminating unnecessary referral would reduce health care costs. By using laptop computers and multipurpose ECG equipment, the two hospitals in remote areas of Bhutan were connected with the Asia Pacific Telecommunication (APT) supported second opinion center at Tokai University, Japan, through dial-up type workstation linking with Public Switched Telephone Network (PSTN) and internet The second opinion center interpreted ECGs and Echocardiograms and made recommendations to the physicians of both hospitals in Bhutan. The system was started in March 2003 and since than 60 studies was transmitted over IP protocol. The results of ECG and Echocardiographic images transmitted to the APT supported second opinion center at Tokai University, showed promising results. This practical experience has shown the most appropriate use of dynamic information technology, using PSTN, to improve the diagnosis, management and quality of life of patients with cardiovascular diseases in remote and difficult in access areas of Bhutan.