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Availability of low-cost, reliable, and portable Electrocardiography (ECG) devices is still very important in the medical world today. Despite the tremendous technological advancement, Cardiovascular Diseases (CVDs) remain a serious health burden claiming millions of lives on an annual basis globally. This is more prevalent in Low and Middle-Income Countries (LMICs) where there are huge financial instability and lack of critical infrastructure and support services for the health care system. Efforts aimed at reducing the prevalence of CVDs are confounded by late diagnosis, frequently, caused by lack of access to or non-availability of basic diagnostic modalities such as the ECG. Hence effective mitigation of the effect of CVDs in LMICs depend on the development of such devices at low-cost with reliability, accuracy and energy efficiency. This paper therefore, was developed to understand the state of the art of low-cost ECG acquisition systems with respect to design features and system capabilities for different use cases. In addition, different design options and taxonomies of available low-cost ECG devices, case studies reports of efficacy tests have been provided. The paper proposes a generalised ECG framework and provides implementation challenges and open research directions that should be considered when developing such devices for proper management of CVDs.