Which Specialty Manages POTS?
POTS should be managed by cardiology or neurology specialists with expertise in autonomic disorders, with referral to these specialties recommended for diagnostic testing and ongoing management. 1
Primary Specialty Referral
Cardiology or neurology are the appropriate specialty referral destinations for POTS management, as explicitly stated in the 2025 American Gastroenterological Association guidelines. 1
The cardiologist plays a central role in both evaluation and management of dysautonomia, including POTS, and can help patients with severe disability achieve near-normal functioning. 2
Autonomic physicians (typically cardiologists or neurologists with specialized training) should form the core of the primary management team alongside general practitioners. 3
Multidisciplinary Care Structure
The primary care team should consist of a general practitioner and trained autonomic physicians with specialist nurses and allied health professionals, as the complexity of POTS necessitates extended appointment times and frequent follow-ups. 3
Gastroenterology may be involved when patients present with disorders of gut-brain interaction and overlapping gastrointestinal manifestations, but should refer to cardiology/neurology for autonomic testing and POTS-specific management. 1
Additional specialists may be required to manage affected organ systems (e.g., gastroenterology for GI symptoms, allergy/immunology for mast cell activation syndrome), but cardiology or neurology remains the primary managing specialty. 1, 3
When to Refer
Referral to cardiology or neurology is indicated for postural vital sign testing (symptomatic heart rate increase ≥30 bpm with 10 minutes of standing during active stand test or head-up tilt table test in the absence of orthostatic hypotension). 1
Patients with stable narrow QRS-complex tachycardia who are drug-resistant, drug-intolerant, or desire freedom from lifelong therapy should be referred to an arrhythmia specialist. 1
After successful termination of wide QRS-complex tachycardia of unknown etiology, patients should be referred to an arrhythmia specialist. 1
Critical Context
There is a significant shortage of medical specialists or general practitioners specializing in autonomic medicine, creating limited availability of POTS care despite a growing patient population. 3
POTS is frequently underdiagnosed and poorly understood by most healthcare professionals, resulting in significant diagnostic delays and patients being mistaken for having malingering, depression, or anxiety disorders. 3, 4
The 2003 ACC/AHA/ESC guidelines note that excessive sinus tachycardia may occur in response to upright posture (POTS), but this is mentioned only in the context of sinus tachyarrhythmias requiring cardiology evaluation. 1