Pakistan's army described the damage as widespread and said it included villages buried in quake-induced landslides.
Pakistan's Geo television quoted Maj. Gen. Shaukat Sultan, the Pakistani army's chief spokesman, as saying 1,000 people were feared dead. Pakistani army officials who flew over quake-hit areas reported seeing hundreds of flattened homes in villages north of the capital Islamabad.
"The damage and casualties could be massive and it is a national tragedy," Sultan told The Associated Press. "The is the worst earthquake in recent times."
The U.S. Geological Survey said on its Web site the quake hit at 8:50 a.m. local time and had a magnitude of 7.6. It was centered about 60 miles northeast of Islamabad in the forested mountains of Pakistani Kashmir.
Damage was extensive in Kashmir, the disputed Himalayan territory divided between India and Pakistan. Officials in the Indian-controlled portion reported 190 dead, including 20 soldiers who perished in a landslide. At least 800 were injured.
Air force and army personnel helped civilian authorities rescue people trapped under buildings. Telephone lines were down. Bridges had developed cracks, but traffic was passing over them.
At least 100 people died in Mansehra district in Pakistan's North West Frontier Province, and 70 percent of mud-brick homes in quake-hit areas collapsed, said Asif Iqbal, the provincial information minister.
More than 60 people died, many of them buried in debris, in a village near Kaghan valley in the same province, said Ataullah Khan Wazir, a regional police chief. He said one Chinese engineer working on a water dam project died and another was injured when boulders loosened by tremors hit them.
In eastern Afghanistan, an 11-year-old girl was crushed to death when a wall in her home collapsed, said police official Gafar Khan. In the Afghan capital of Kabul, a teacher died when the shock of the quake triggered a heart attack, officials said.
The quake brought down a 10-story apartment building in Islamabad and dozens of people were feared trapped in the rubble. Rescuers pulled out at least 20 injured people. Some residents were Westerners, a building employee said.
A man named Rehmatullah who lived nearby said he saw dust from the buckled building from his bathroom window.
"I rushed down, and for some time you could not see anything because of the dust. Then we began to look for people in the rubble," said Rehmatullah, who only gave one name. "We pulled out one man by cutting off his legs."
"It was like hell," said Nauman Ali, who lived in a nearby top-floor apartment. "It was terrible. I was tossed up in my bed and the ceiling fan struck against the roof."
Aided by two large cranes, hundreds of police and soldiers helped remove chunks of concrete, one splattered with blood. A rescue worker said he initially heard faint cries from people trapped in the rubble.
Pakistani President Gen. Pervez Musharraf and Prime Minister Shaukat Aziz ordered the military to extend "all-out help" to quake-hit areas and appealed to the nation to stay calm.
Pakistani troops and helicopters deployed to earthquake-hit areas. Landslides were hindering rescue efforts in some areas.
Sultan, the army spokesman, said the worst-hit areas were in Pakistani-controlled Kashmir, including Muzaffarabad, the regional capital, and the towns of Bagh and Rawalakot. The districts of Batagram, Balakot, Mansehra, Abbottabad and Patan in northwestern Pakistan were also badly hit, he said.
Dozens of homes, schools, mosques and government offices were damaged in those areas, and hundreds of injured people were taken to hospitals.
Pakistan's foreign ministry said it received many offers from foreign governments to send rescue teams and relief aid, and would respond after assessing the damage. The U.S. Embassy in Islamabad said it would provide $100,000 in emergency relief funds, and that the U.S. military had offered to help.
In the capitals of Pakistan, India and Afghanistan, buildings shook and walls swayed for about a minute. Panicked people ran from their homes and offices. Tremors continued for hours afterward.
U.S. military spokesman Lt. Col. Jerry O'Hara said the quake was felt at Bagram, the main American base in Afghanistan, but he had no reports of damage at bases around the country.
"It was so strong that I saw buildings swaying. It was terrifying," said Hari Singh, a guard in an apartment complex in a suburb of India's capital, New Delhi. Hundreds of residents raced down from their apartments after their furniture started shaking.
The quake also jolted parts of Bangladesh, but no casualties or damage were reported there.
In 1935, a 7-5-magnitude temblor struck the Indian city of Quetta, now part of Pakistan, killing more than 30,000 people.
In 1993, as many as 10,000 died in an earthquake of 6.0 magnitude that struck the state of Maharashtra in India. In 2001, a 7.7 magnitude earthquake devastated much of the western Indian state of Gujarat, killing more than 13,00