Pain in the middle of the chest like choking may be caused by different reasons: First, it may be a heart disease, if the choking pain in the middle of the chest occurs when you move around, sometimes it may lead to radiation in the left shoulder, which can be relieved when you rest. First of all, it is necessary to visit the cardiology department in time, it may be a manifestation of unstable angina. Second, if the pain in the middle of the sternum is like choking when it is related to diet, there is a choking sensation when eating, and for example, it is getting heavier and heavier when eating liquid food, it can be said to be a progressive choking sensation, and this is when the esophagus is diseased. For elderly people with progressive choking sensation, it is important to exclude the possibility of esophageal cancer. In addition to esophageal cancer, reflux esophagitis or cardia incontinence can cause pain behind the sternum like choking. In this case, endoscopic examination may be required to help make a clear diagnosis. Third, there are also psychogenic, such as too nervous, too anxious, this time although the electrocardiogram is also normal, and the gastroscopy is also normal, but feel the pain behind the sternum feel choking. In this case, it may be necessary to relax and maintain a good mood, and to keep sleeping in order to effectively relieve the symptoms.