Claudine Manizabayo was suffering from shortness of breath and a cough. At first, doctors mistook her symptoms for asthma. Then a clinical team specializing in non-communicable diseases examined her and came back with a different diagnosis--heart failure. In affluent countries like the United States, the symptoms and the diagnosis are feared and familiar among the elderly and people with coronary artery disease. Claudine is only 18. In poor countries like Rwanda, where she grew up in a family of farm laborers, heart failure often afflicts the young and the destitute.