The epicenter of the quake, which struck at a depth of 84 kilometers (52 miles), was in the coastal district of Escuintla, less than 100 kilometers southwest of the capital, Guatemala City.
The United States Geological Survey said it measured as a 6.2-magnitude quake, though Guatemalan authorities estimated it was stronger, at 6.8, followed by an aftershock of 4.8.
The quake caused landslides on roads, damage to houses and power outages affecting some 31,300 people, according to rescue services.
Three women died of heart attacks, which officials linked to the quake without specifying how they were related.
One woman, 50, died in the village of Mixco, west of the capital. The other two women, whose ages authorities did not give, were in the northern department of Baja Verapaz and the western city of Quetzaltenango.
The tremor was felt as far away as El Salvador, to the southeast of Guatemala, and in southern Mexico.
Firefighters also reported a landslide on the road from the capital to Antigua, Guatemala's main tourist city.
The Central American country, located at the meeting point of three tectonic plates, sits in a risk zone for earthquakes.
Last year, more than 125 earthquakes were recorded in Guatemala, without any deaths or significant damage.
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