It sometimes happens that a person dies shortly after the death of their spouse.
This phenomenon is often referred to as broken heart syndrome, the widowhood effect, or more technically, takotsubo cardiomyopathy.
“Broken heart syndrome is a social condition that shows if your wife or husband dies, your mortality goes up and stays elevated for years. So you can almost ‘catch’ death from your spouse. It’s not a coincidence, it’s an effect,” Felix Elwert, Ph.D., associate professor of sociology at the University of Wisconsin-Madison, told Healthline.
Elwert says that broken heart syndrome is one of the oldest known findings in social demography. There has been about 150 years of research on this condition.
However, this phenomenon is still somewhat of a mystery.
Elwert’s 13 years of research on the topic helps point to some answers.
More Than a Romantic Sting
There may be a romantic notion of one not being able to live without the love of a spouse, but Elwert says there’s more to the story.
His research points to practical reasons that are gender specific.
“People do stuff for each other other than love each other. Of course, many couples do maintain a kind of butterflies in the belly love, but later in life the relationship becomes much more of a companionship. Even if they’re not writing each other secret letters under the desk anymore, the death of a spouse in general can harm one’s health because they’re losing material services,” he said.
For example, for people over 75 years old, Elwert says most men struggle with cooking and cleaning.
“In that generation, by and large, those were the wife’s role, so if I’m an older male and I’m a type 2 diabetic, even a few weeks of irregular and poor meals or perhaps self-medication of chocolate might push me over the edge,” he said.
On average, women tend to be two to three years younger than their husbands and often stay mentally fit a little longer. So, Elwert says, they are often in charge of reminding their husbands when to take their medication, making their husbands’ doctors’ appointments, and coordinating their social activities.
“If the wife dies, the nurse dies and the social secretary dies. Even if the couple has fallen out of love and nobody’s heart is broken, all of these things we know are harmful to survival are affected. We need to eat regularly, take medication regularly, and to have social contact regularly so we don’t shrivel inside,” Elwert said.
When older women lose their husbands, Elwert says they’re affected in different ways, primarily financially.
“Social Security benefits are tied to how people survive and husbands in the elderly population tend to be the primary wage earners. Widows receive a widow’s pension, which is quite a bit lower so she may have to move because living alone is more expensive than living together and this can be stressful,” said Elwert.
A Case of Race
Researchers have a database of half a million Americans and tens of thousands of African Americans, but Elwert says they didn’t find instances of broken heart syndrome among African Americans.
“We estimated really precisely that this effect is essentially zero. This means that marriage doesn’t prolong the life of African Americans as it does for whites. This doesn’t mean that African Americans don’t benefit from marriage, it means that they benefit longer. For whites the marital benefits disappear when the marriage ends, and for African Americans the marital health benefits last beyond the death of a spouse,” Elwert stated.
While there’s no scientific evidence to prove why this is the case, Elwert says one theory is that the cultural context of marriage differs between groups.
“One thing that we know for a fact is that elderly widowed whites tend to live alone, but elderly widowed African Americans live with other relatives. Sure, I believe there’s a psychological broken heart component, but most of the stories I’ve told are really about having a caretaker in the home. Somebody to whom I’m not just furniture but who has sympathy for me. That could be a another relative, a child, a younger sibling, whoever,” he said.
Another theory is that in the current generation of elderly, African Americans have more equitable marriages and practice a weaker division of labor than whites do.
“Think of 80-year-old whites now, it’s clear the husband’s job was to work and the wife’s was the homemaker. For African Americans that’s less true. African American elderly husbands are more likely to contribute to household labor than whites, and African American elderly wives were more likely to participate in the labor force than whites, which means they’re less dependent on each other,” Elwert said.
A Physiological Connection
While the social components of broken heart syndrome refer to the long lasting effects of losing a spouse, the American Heart Association (AHA) defines the medical condition as a “sudden, intense chest pain — the reaction to a surge of stress hormones — that can be caused by an emotionally stressful event” with established ties between depression, mental health, and heart disease.
When this happens, part of the heart enlarges and doesn’t pump well, but the rest of the heart functions normally. Eventually, all heart function returns to normal.
Broken heart syndrome is often misdiagnosed because the symptoms are similar to a heart attack. However, according to the AHA, broken heart syndrome doesn’t show any evidence of blocked arteries.
Dr. Harmony Reynolds, a cardiologist and associate professor of medicine at NYU Langone Medical Center, says physical stress, such as running a marathon, and emotional stress, such as receiving bad news, can trigger the syndrome.
“I always worry that when people read about broken heart syndrome and they learn that this completely goes away and that their heart function recovers completely, they’ll think ‘I’m just having chest pain because I broke up with my boyfriend or got really bad news and it’ll go away, so I won’t go to the hospital,’” Reynolds told Healthline.
“People who have chest pain, no matter what the scenario, whether they think it’s broken heart syndrome or a heart attack or indigestion for that matter, when you’re not sure, have to go to a hospital and have doctors check it out,” she said.
Reynolds recently conducted a study evaluating how the parasympathetic system, which helps the body calm down after a fight or flight response, plays a role in broken heart syndrome.
Common belief is that the sympathetic nervous system, which produces adrenaline, must be involved since there is a relationship between broken heart syndrome and extreme emotional or physical stress.
“But we knew that wasn’t the whole story because not everyone has extreme emotional or physical stress when they have this problem and because the beta blocking group of medicines that blunt the body’s adrenaline reaction didn’t work to prevent the syndrome from coming back [in women who had broken heart syndrome]. So if it were all about the adrenaline system, those medicines should have been effective,” said Reynolds.
By studying both systems in 20 women who had experienced broken heart syndrome, Reynolds found that both systems were out of balance.
“We think that makes the body’s response also out of balance and that may explain why these beta blocking drugs don’t work for prevention,” she said.
Whether or not broken heart syndrome may be the cause of death in the widowed, Reynolds says, “Many people who are grieving or otherwise feel like their hearts are broken don’t run to hospitals, as they should when they have symptoms. I definitely think that broken heart syndrome could be the reason that someone dies after hearing bad news, but regular heart attacks also happen right after people receive bad news or have other major stressors.”
Can Broken Heart Syndrome Be Prevented?
Reynolds says that the natural response to her study is to consider ways to make the parasympathetic system stronger. Researchers could then look for recurrence or even how to prevent broken heart syndrome.
“The things we know that make the parasympathetic system stronger in everyday life are exercise and relaxation techniques, such as yoga, which are very different than the usual medical approach of giving medicine or doing invasive procedures,” Reynolds said. “In this case, if we’re right and the parasympathetic system is what we need to focus on, then that focus should be on exercise and relaxation breathing.”