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Under normal physiological conditions, the body operates through the intricate coordination of multiple organs, with the heart serving as a central energy engine that communicates with other organs. Conversely, both physiological and pathological states can influence cardiac activity via neural and humoral regulation. Extracellular vesicles (EVs) are nanoscale, lipid-bound particles secreted by nearly all cell types. These vesicles are rich in proteins, lipids, sugars, and genetic material, facilitating intercellular communication. EVs achieve this by fusing with or being endocytosed by recipient cells, thereby transferring bioactive molecules. While considerable research has explored the role of EVs in inter-organ communication, the specific mechanisms by which EVs link the cardiovascular system to other organs remain insufficiently understood. This review aims to elucidate the critical function of extracellular vesicles in bridging the cardiovascular system and other organs, with particular emphasis on intracardiac communication and major inter-organ communication pathways, providing a comprehensive analysis of recent findings in this evolving area of study.