This paper proposes an energy efficient ECG monitoring system by putting some intelligence on the sensor node to reduce the number of transmissions. The sensor node is mostly put into the processing mode and just connects the base station when necessary. Therefore, the transmission energy is greatly reduced while the energy for processing is increased a little bit. Our proposed ECG analysis method classifies ECG cycles by computing the Euclidean distance between the sensed ECG cycle and the reference ECG cycle. This work is a detailed and full explanation of our former work. Extended experimental results show that the proposed trade is very effective in saving energy and the Euclidean distance based classification method is accurate. Furthermore, the PowerTOSSIM energy simulation method is also demonstrated as very accurate in evaluating the energy consumption of the sensor node in our application scenario.