Heavy metal contamination in coastal fisheries represents a growing global environmental and public health challenge. Industrial discharge, urban runoff, and atmospheric deposition introduce toxic metals including mercury, cadmium, lead, and chromium into marine ecosystems, where they bioaccumulate in fish tissues through complex uptake mechanisms. This contamination poses significant risks to both marine biodiversity and human consumers, particularly vulnerable populations dependent on seafood for protein. This article examines the sources and pathways of heavy metal pollution, bioaccumulation mechanisms in marine fish, health risk assessment methods, and current remediation strategies. Recent studies reveal concerning trends in metal concentrations across coastal regions, with mercury showing particular biomagnification potential through marine food chains. Effective management requires integrated monitoring, improved pollution controls, and risk-based consumption guidelines to protect both ecosystem health and food security.