The medical term for fainting is syncope and this is the sudden loss of consciousness generally caused by having

a low blood pressure (hypotension) and insufficient levels of glucose and oxygen (hypoxia) reaching the brain. Fainting causes an increase in flow of the blood to the brain In the case of the elderly female patient, fainting occurred due to orthostatic hypotension which is also commonly known as postural hypotension. Orthostatic hypotension is where the patients blood pressure suddenly falls when the person stands up from the supine position. During the supine position, the patient is conscious and the venous return (amount of blood that returns to heart in veins) is maintained easily. As the patient immediately stands up, gravity causes the blood to pool in the lower limbs, thus reducing the central venous pressure and therefore the venous return. Starlings law states that the greater the volume of blood entering the heart during diastole, the greater the volume of blood ejected during systolic contraction and vice versa. This means that the cardiac output is linked to the venous return. As the patient stands up immediately, her venous return is decreased and so her cardiac output will also decrease and consequently lead to a fall in arterial blood pressure - hypotension. The overall effect of this hypotension is insufficient blood perfusion in the upper part of the body - notably the brain and therefore causing the patient to faint. Orthostatic hypotension occurs in everyone who stands upright immediately from a supine position but not everyone faints. The reason for this is because of the negative feedback control mechanism called the baroreceptor reflex which helps maintain the blood pressure. The sensory receptors in this reflex are known as baroreceptors and these are found in the walls of the blood vessels in the region of the carotid sinus, brachiocephalic trunk and the aortic arch. The baroreceptors are sensitive to the stretching of the blood vessels which happens because of blood pressure. When blood pressure is low, the baroreceptor reduce their rate of action potential generation which are conducted via the glossopharyngeal and vagus nerves to the cardioregulatory and vasomotor centre in the medulla oblongata of the brian. As a result of the decrease of baroreceptor activity, the cardioregulatory centre decreases the parasympathetic stimulation to the heart via the vagus nerve and the cardiovascular centre increases stimulation to the heart - thus causing an increase in heart rate and stroke volume. The vasomotor centre regulates sympathetic activity which controls the level of constriction of the arterial vessels. The baroreceptor activity inhibits the vasomotor centre and therefore the lower the activity the greater the sympathetic tone to the blood vessels which causes vasoconstriction which in turn causes an increase in blood pressure towards normal. The reason why the patient fainted and why staff should have been more careful was because she was elderly and and with age the autonomic function is reduced and so the feedback mechanism does not work effectively. Also with age the cardiac output decreases and with venous pooling, the cardiac output decreases further to an extent where the baroreceptor reflex mechanism is overwhelmed and so the patient faints. With age the blood vessels become calcified (hardened and loss of elasticity) with deposits of cholesterol - atheroscelerosis. This means that amount constriction of the blood vessels due to the reflex will be greatly reduced and so it will be difficult to increase the arterial blood pressure and therefore the flow of blood to the brain.

Gravity: The effects of gravity on venous return seem paradoxical because when a person stands up hydrostatic forces cause the right atrial pressure to decrease and the venous pressure in the dependent limbs to increase. This increases the pressure gradient for venous return from the dependent limbs to the right atrium; however, venous return actually decreases. The reason for this is when a person initially stands, cardiac output and arterial pressure decrease (because right atrial pressure falls). The flow through the entire systemic circulation falls because arterial pressure falls more than right atrial pressure; therefore the pressure gradient driving flow throughout the entire circulatory system is decreased.