The vagus nerve is the main parasympathetic nerve to the heart, providing rest and digest counterbalance to sympathetic fight or flight signals. Vagal stimulation slows heart rate, reduces contractile force, and promotes coronary artery dilation. The right vagus nerve has denser cardiac projections than the left, explaining avoidance of right-sided stimulation in VNS to prevent bradycardia or transient asystole. Through cardiac branches, the vagus nerve influences heart rate by slowing the sinoatrial node, rhythm by modulating atrioventricular node conduction, contractility by reducing force during rest, coronary blood flow by dilating arteries, baroreceptor sensitivity for blood pressure responses to position changes, and heart rate variability. Heart rate variability (HRV) measures variation in time between consecutive heartbeats. Higher HRV reflects dynamic sympathetic-parasympathetic interplay, stronger vagal tone, better autonomic balance, improved cardiovascular health, lower stress, and reduced mortality risk. Low HRV indicates vagal withdrawal and sympathetic dominance, linked to increased risk of coronary artery disease, heart attacks, sudden cardiac death, heart failure progression, hypertension, type 2 diabetes, all-cause mortality, chronic stress, burnout, anxiety, depression, poor physical fitness, inflammation, aging, and reduced longevity. Vagus nerve stimulation (VNS) targets cardiovascular conditions. In chronic heart failure, VNS restores autonomic balance, potentially improving cardiac function, exercise tolerance, and quality of life; early trials show promise as adjunctive therapy. For arrhythmia management, VNS modulates electrical conduction, relevant for atrial fibrillation and supraventricular arrhythmias, potentially reducing episodes or enhancing treatment outcomes. In hypertension, VNS enhances baroreflex sensitivity for blood pressure regulation during postural changes and stress, offering benefits for resistant cases. Post-myocardial infarction, VNS addresses persistent autonomic dysfunction to improve long-term outcomes and prevent recurrence. In coronary artery disease, vagal stimulation promotes vasodilation, improves endothelial function, and may reduce atherosclerotic progression.