Fish not only constitute an important trophic level in aquatic ecosystems but also serve as an important source of protein for human beings. The health of fish is related to the sustained and healthy development of their entire aquatic ecosystem. Due to the widespread use, mass production, high disposal frequency, and degradation resistance of plastics, these pollutants are released into aquatic environments on a large scale. They have become one of the fastest growing pollutants and have a substantial toxic effect on fish. Microplastics have intrinsic toxicity and can absorb heavy metals discharged into water. The adsorption of heavy metals onto microplastics in aquatic environments is affected by many factors and serves as a convenient way for heavy metals to migrate from the environment to organisms. Fish are exposed to both microplastics and heavy metals. In this paper, the toxic effects of heavy metal adsorption by microplastics on fish are reviewed, and the focus is on the toxic effects at the individual (survival, feeding activity and swimming, energy reserves and respiration, intestinal microorganisms, development and growth, and reproduction), cellular (cytotoxicity, oxidative damage, inflammatory response, neurotoxicity, and metabolism) and molecular (gene expression) levels. This facilitates an assessment of the pollutants’ impact on ecotoxicity and contributes to the regulation of these pollutants in the environment.