This paper explores the transformation of electrocardiogram (ECG) monitoring from traditional offline to Real-Time analysis, enabled by high-speed mobile networks and affordable data plans. The transition to live monitoring presents challenges in data streaming and processing and the necessity of balancing immediacy with accuracy. We optimize two critical aspects of cloud architecture and scalability under the broader umbrella of cloud efficiency by evaluating the architecture’s components and their contribution to overall efficiency. The focus is on accommodating over a thousand concurrent patients streaming ECG data while maintaining cost-effectiveness, constrained by Near Real-Time Round Trip Time (RTT) of $\leq 3$ seconds, achieving a throughput of $\geq 333.333($ msgs/s).