In this review, we evaluate and summarize the available data that addresses the levels of HM that exist in aquatic species, mainly fish, of Pakistan. Data on this topic were collected from the literature of the last two decades (1990-2012). Results revealed that the highest number (>50%) of studies addressing HM-contaminated fish have occurred in the Punjab province, followed by the Sindh and Khyber Pakhtunkhwa provinces. Our review disclosed that the HM concentrations in Pakistani fish species varied considerably with location. Generally, the level of HM residues detected in fish species had the following descending order: Fe>Zn>Pb>Cd>Hg>Ni>Cu>Ag>Cr>Mn>As. Fish samples collected from the Kabul River near the Nowshera district, Stretch of Ravi River, Indus River near Mainwali district, and Arabian Sea at Karachi revealed extremely high HM concentrations (range: 0.34-8,381.30 jlg/g), compared to other fresh water bodies, such as the Llyold Barrage, Guddu Barrage, Jinnah Barrage, and Chashma Barrage (0.01-2.13 jlg/g). As a reference point, we also reviewed selected data on HM fish residues that exist in countries that neighbor Pakistan. With the exception of fish collected in India, the majority of fish analyzed for HM residues in neighboring countries displayed lower residues than did fish from Pakistan. We concluded from reviewing the available published data that the most probable sources for the HM contaminants found in Pakistani water and fish were release of domestic sewage, agricultural runoff, and industrial effluents. We strongly recommend that action be taken to better control the discharges of unregulated waste that enters the Pakistani aquatic environment, with the intent to mitigate any continuing future damage to the aquatic ecosystem. We also recommend intensifying research programs that address the toxicity of HM to the aquatic environment, so that a better understanding of metal effects on fish can be achieved that will lead to a sustainable ecological harmony in Pakistan.