The concentration of heavy metals in the aquatic environment has rapidly increased over the years due to natural and various anthropogenic activities, and it has become a global concern due to the impact on aquatic and terrestrial organisms, including human health. Heavy metals’ bioaccumulation and biomagnification nature means they can remain in the environment for a long time and move up in the food chain, causing various physiological effects among organisms. The review focuses on the ecotoxicology and pre-remedial risk assessment of heavy metals in aquatic environments. The malformation and physiological effects in fish have been reported due to environmental pollution caused by heavy metals, which manifest in fin loss, gill underdevelopment, liver dysfunction, and fin functions in fingerlings. The ecotoxicity of heavy metals not only affects aquatic organisms and their environment but poses a severe threat to human health. The review provided a further understanding of the ecotoxicological effect and pre-remedial risk assessment approaches to enhance the prevention of heavy metal pollution in the aquatic environment.