A patient with apical hypertrophic cardiomyopathy and myocardial infarction complicated by intramural haematoma of the left ventricle is presented. The angiographic examination confirmed atherosclerotic etiology of myocardial infarction. The other reasons of myocardial ischaemia in a hypertrophic cardiomyopathy are discussed, pointing at multi-factorial pathogenesis of myocardial infarction in this disease. Probable mechanisms of this rare complication and its prognostic value are also analysed.