By George Dohrmann
May 22, 2010

Seven months ago, Zachary Herold was the starting right back for the United States at the U-17 World Cup in Nigeria and a promising prospect for the senior national team. Three months ago, Toronto FC selected Herold in the second round of the MLS Super Draft, and the team's director of soccer, Mo Johnston, called him "one of the best young kids in the country."

Today, his soccer career is over.

Diagnosed with Hypertrophic cardiomyopathy (HCM), which causes abnormal thickening of a part of the heart muscle, Herold announced his retirement last week before he ever appeared in an MLS game. It was a blow to Toronto FC, to the U.S. youth system that had nurtured Herold for years, and to the 17-year-old who suddenly had his dreams dashed.

"When they first [diagnosed] me, I was shocked, everyone was shocked," Herold said Friday. " I had played at the highest level for so long and had no signs ... I was upset."

Herold was diagnosed before the season when a routine Electrocardiography (ECG) revealed the problem. He subsequently got a second and third opinion, which confirmed the initial diagnosis. The emotion over being told he wouldn't be able to play competitive soccer again clashed with the realization that he was lucky to be alive. One study of the sudden death of 158 young athletes found that 48 (or 36%) were the result of undiagnosed HCM.

Herold and his family thought back to all the high-level soccer he played over the years and how he could have died at any moment. "He dodged a bullet. I don't want to think what could have happened," said his mother, Beth.

There is no cure for HCM, not medication or surgery that would permit him to play again. The only option is to put life restrictions on exercise. "[The doctors] told me I cannot get my heart going above 130 beats a minute," Herold said. "That's not really doing much. I can workout, but there are limitations, like I can't lift big weights. My whole life has been changed."

Herold talked about staying connected to soccer, either as a coach or as an agent. With all he has learned about his heart in the past months, he is interested in cardiology and might shoot for medical school.

"Part of the Generation Adidas program is to provide college education unequivocally," said Herold's agent, Richard Motzkin. "MLS has agreed to support Zach in that fashion."

Whatever Herold chooses to do, he says he will advocate for ECGs to become routine for young athletes, particularly those competing at the highest levels. He won't be alone in that pursuit. A recent study at Stanford concluded that earlier claims that ECGs were too expensive to make mandatory for athletes were inaccurate.

"According to our model, ECG together with a history and physical exam is the preferred strategy for screening athletes for underlying heart disease. This would save the most lives at a cost that is generally agreed to be acceptable for the U.S. health-care system," said Dr. Matthew Wheeler, the first author of the study.

The Stanford cardiologists looked at results of ECG heart screenings of athletes in Italy, where screening has been mandatory since 1982. As a result of that policy, sudden death by athletes during competition has decreased by almost 90%.

The Stanford study estimated that the cost to screen athletes in the United States for conditions like HCM would cost approximately $88 per athlete and save 2.1 life-years per 1,000 athletes screened.

"People who are playing for high school teams, playing in state finals, competing at high level, they should get them," Herold says. "I played for national team for three or four years, and I never had a heart [ECG]. If they would have gotten me checked earlier all of this would have been prevented. It should be covered way before someone gets to the pro level."

On Saturday, Toronto FC honored Herold before its game against the New England Revolution. It was a nice gesture, and offered some closure for a soccer career that ended abruptly and far too soon.

"I made it to the pro level and I traveled the world with the national team," Herold said. "And I've still got my whole life ahead of me."

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