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On 12 November 2019, an exceptional flood event took place in Venice, second only to the one that occurred on 4 November 1966. Moreover, with four extremely high tides since 11 November 2019, this was the worst week for flooding in Venice since the beginning of sea level records (1872). The event that struck Venice and the northern Adriatic Sea on 12 November 2019, although having certain conditions seemingly typical of the events causing exceptional high waters, had some peculiar characteristics not observed before, which deserved an in-depth analysis. Several factors made this event exceptional: the in-phase timing between the peak of the storm surge and the astronomical tide; a deep low-pressure cyclone over the central-southern Tyrrhenian Sea that generated strong Sirocco (south-easterly) winds along the main axis of the Adriatic Sea, pushing waters to the north; a fast-moving local depression – and the associated wind perturbation – travelling in the north-westward direction over the Adriatic Sea along the Italian coast, generating a meteotsunami; very strong winds (28 m s − 1 on average with 31 m s − 1 gusts) over the Lagoon of Venice, which led to a rise in water levels and damages to the historic city; and an anomalously high monthly mean sea level in the Adriatic Sea, induced by a standing low-pressure and wind systems over the Mediterranean Sea, that was associated with large-scale low-frequency atmospheric dynamics. In this study, the large set of available observations and high-resolution numerical simulations have been used to quantify the contribution of the mentioned drivers to the peak of the flood event and to investigate the peculiar weather and sea conditions over the Mediterranean Sea during the Venice floods of November 2019.