Due to rapid urbanization and industrialization, heavy metal (HM) pollution in coastal areas of the East China Sea (ECS) has attracted extensive attention. This article attempts to review recent studies on the temporal and spatial distributions, ecological risks, and possible sources of HMs in typical bays and estuaries of ECS. The levels of HMs are closely related to local economic development and local characteristics. The anthropogenic activities and the particle size of sediments are important factors affecting the distribution of HMs. During the late 1970s to the 1990s, HMs levels in the Yangtze Estuary (YRE) sediments showed an upward tendency due to the increased emissions. However, HMs levels in the early 2000s were lower than that in the late 1970s to the mid-1990s. Cd caused serious pollution and brought potential ecological risks in the Yangtze Estuary, Hangzhou Bay (HZB), Sanmen Bay (SMB), and Quanzhou Bay (QZB). In Fujian province of China, the Quanzhou Bay was heavily polluted by HMs and high contents of HMs were found in biota. Among different species, molluscs in the coastal areas of ECS have the highest levels of HMs exceeding safety limits.