A study on contamination status and ecological risk of heavy metals in surface sediment at selected sites on Kelantan River and its nearshore area was carried out. Ten samples along Kelantan River and 25 samples from the nearshore were analyzed using inductively coupled plasma optical emission spectrometry (ICP-OES) to determine heavy metal concentrations. Sediment samples were also analyzed for particle size compositions, total organic matter and pH content. The average concentrations for As, Cd, Cr, Cu, Mn, Ni, Pb, Zn were 7.38, 1.31, 17.71, 11.40, 507.15, 5.97, 22.61, 32.95 mg/kg for riverine and 14.14, 4.59, 29.79, 14.07, 389.96, 9.65, 62.21, 41.04 mg/kg for nearshore samples respectively. The potential ecological risk index showed stations Bekok, Manek Urai, and RH under considerable risk followed by station Pasir Mas under moderate risk. The pollution load index classified four nearshore sites (KW10, KW17, KW18, KW37) as polluted. The geo-accumulation index (Igeo) categorized moderate contamination for Cd and Pb. The enrichment factor (EF) along the river categorized extremely high enrichment for Cd, and significant enrichment for As, Pb and Mn while Pb and As were under very high and significant enrichment in nearshore areas. Pb, Cu, Zn, As, Ni and Cr showed significant correlations with each other.